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REVIEW / ANALISA
Women and cardiovascular disease: At a social
disadvantage?
Cardiovascular disease (CVD) is the leading health and
economic burden throughout the world, particularly in
industrialised countries. By 2020 CVD will be the most
burdensome public health issue globally (AIHW, 2008a;
World Health Organization, 2009). A sharp increase in
the prevalence of diabetes has led to an increase in
the associated complications of hypertension,
hyperlipidaemia
and atherosclerotic vascular disease (America Heart
Association (AHA) 2004, 2005). For the Australian
population,
‘‘cardiovascular diseases as a group contributed to 54%
of all male deaths and 59% of all female deaths’’
(AIHW,2010a, p. 52). Throughout the lifespan, health
disparities
can contribute to inferior outcomes (Lewis, DiGiacomo,
Currow, & Davidson, 2011).
In the United States, CVD is the leading cause of death in
postmenopausal women and far outweighs death rates
from
all types of cancer combined (AHA, 2002, 2005). Over the
last decade CVD is also the most common cause of death
in
the European Union, accounting for 1 in 7 deaths in
women
(BHF, 2008; BNF, 2000). In 2007 the Australian Institute
of
Health and Wellbeing recorded CVD as the main cause of
death for Australians, with over ‘‘78% of the CVD deaths
were of people aged 75 years and over, and more than half
were female (52.7%)’’ (AIHW, 2010a, p. 141).
In Australia more than 26,000 women per year die from
CVD, accounting for 41% of all female deaths (AIHW,
2004).
The proportion of Australian women reporting CVD was
higher than for males in every age group except those 75
years and over. While the age-standardized incidence of
major coronary events fell, both male and female incidence
rates increase with age. Cerebrovascular disease affected
more women than men in Australia in 2005 accounting for
9% of all deaths. Most of these deaths (83%) occurred

. and psychological/ social and include advancing age. and high cholesterol. It also identifies areas for future interventions with a view to improving outcomes in women with cardiovascular disease. The risk factors associated with CVD can becategorised into behavioural. Of concern is that women are over represented among low incomeearners and under-represented among higher . 2008a). high blood pressure. CINAHL. and ‘socioeconomic status’.Women and cardiovascular risk Cardiovascular risk factors accounts for over 30% of Australia’s total burden of death.tobacco consumption. hypertension. . Socioeconomic status (SES) is strongly associated with risk of disease and mortality across many conditions in particular CVD. . the metabolic syndrome. were searched for relevant studies using the search terms ‘women’. ‘cardiovascular disease’. PsycARTICLES. 2008a). This paper provides a critical review of the social issues impacting upon women in Australia. The prevalence and costs of coronary heart disease (CHD) in women is likely to increase due to the ageing female demographic. being overweight or obese. chronic renal disease. The discussion will also identify areas for future interventions with a view to improving outcomes for women with CVD. diabetes. and the increasing numbers of women affected by obesity.Social factors impacting upon cardiovascular risk People with the lowest social and economic status often have the poorest health (Lewis et al. physical inactivity. MEDLINE. disease and disability (AIHW. The references used in this paper were included after reading the texts and subsequent discussion by the authors about the fundamental points intended for this article.3 Purpose/Tujuan Penelitian Method/Metode Penelitian 4 5 Analized/Analisa Penelitian among those aged 75 years or over (AIHW. 2011). family history. The bibliographic databases. biological/medical. A hand search of reference texts and other resources held in the university library was also undertaken. and diabetes. This paper provides a critical review of the social issues impacting upon women who have CVD.

Shipley. & Aroney. The social issues that impact upon women who have CVD can affect symptom recognition. Delay in treatment is associated with increased disability and mortality (Lefler & Bondy. Mass public education programs to decrease delay have up until now focussed on the symptoms of MI and the appropriate response to take (Bett et al. and health seeking behaviour and decision making. & Worrall-Carter. Davidson. & Worrall-Carter. They are likely to smoke. . and a reduction in the time between symptom onset and presentation to hospital can reduce MI mortality (Then. 2004) and is attributed to cultural and historical perceptions about CVD as being ‘a man’s disease’ (Miller & Kollauf. 2011. 1984). Moser et al. Davidson. & Fofonoff.. Importantly. &Rose. 2004. 2004). The importance of prompt access to hospital for diagnosis and treatment of ACS cannot be underestimated. 2010b). 2010. People outside major cities were more likely to place themselves at a higher risk of poor health. 2001). access to services and recovery (DiGiacomo et al. Kuhn. Despite public and targeted education programs and previous experience of CHD (Bett. 2005). Dracup. . Thompson. The highest mortality rate following acute myocardial function occurs in the first 2 h after symptom onset. & Chung. 2010a).Cardiovascular risk and geographical isolation When examining statistics of death rates in Australia the evidence reveals substantial socioeconomic inequality (AIHW. Ferris. . Gholizadeh. McKinley. this disparity in health status follows a gradient.Disparities in treatment and gender The existing underestimation and poor awareness of CVD risk among women is well recognised (Mosca. Salamonson.6 Result/Hasil Penelitian income earners (AIHW. Moser.. 2004. Fabunmi. Rankin..American and Australian women delay seeking help for cardiac symptoms (Mosca et al. & Robertson. 2004). Differences in symptom presentation between women and men has implications for education of the public and health care providers regarding the recognition of sex differences in acute coronary syndrome (ACS) clinical presentation. This is particularly important for Aboriginal and Torres Strait Islanders and those living in remote areas. with overall health improving with improvements in socioeconomic status (Marmot. Page. be overweight and drink alcohol excessively.. 2011). and engage in unhealthy behaviours (AIHW. Tonkin. 2010a). 2002).

2009). taking into account the patient’s age. 2000). risk factors. O‘Sullivan. gender. (McSweeney. these health differentials are more pronounced. such as Indigenous women.Implikasi/Simpulan Penelitian 7 2005). & Davidson. & Crane. Addressing health literacy needs is an important consideration in reducing health disparities and improving population health (Nutbeam. Primary prevention of CVD and prompt treatment for those with symptoms of ACS can only be achieved if women are aware of their CVD risk. Cody. In addition to these factors it is important to address cultural. Health professionals need to provide individualised information regarding possible symptoms of ACS. Social and economic health disparities contribute to poorer outcomes for women and in particular groups. the associated symptoms and the importance of seeking help from emergency services. 2009). Worrall-Carter. 2004) and treatment can be initiated in a timely manner. DiGiacomo. 2008). 2004) so that appropriate diagnostic tests (Maseri. Health disparities are evident for women and these factors contribute to inferior cardiovascular outcomes. Salamonson. New tools have been developed which can help health professionals identify cardiac related symptoms.. the cultural and linguistic diversity of Australia requires an increased focus on health information that targets the needs of migrant women (Gholizadeh et al. Clearly these efforts have been ineffective in decreasing pre-hospital delay for MI. social and economic factors that contribute to health care differentials for women (Gholizadeh & Davidson. In Australia. social circumstances. risk factors and history. . Adopting proactive and enabling strategies to increase awareness of CVD among women and increase accesses to services is an important factor in improving health outcomes for Australian women. (Gholizadeh.