Do us a favour: stop reading this article and search the term "heart attack" in Google Images. What do you see?
Most likely, a sea of anatomical heart models, blocked arteries, and, perhaps more tellingly, countless depictions of men clutching their chests in pain.
There is, of course, nothing inherently malicious about these images. Men are significantly affected by cardiovascular disease. But this simple search reveals a much larger problem that extends far beyond Google Images: women's heart diseases – and the risk factors that cause them - remains both underrepresented and misunderstood.
At its beating heart lies a dangerous reality –risk-factors - like pregnancy, diabetes, thyroid disorders, or kidney conditions like Fibromuscular dysplasia – are often overlooked among women. Preventable cardiovascular disease remains a silent killer, accounting for approximately 42,300 deaths in Australia each year, despite decades of public health messaging and major advances in diagnosis, treatment, and prevention.
Dr Foo says some of the most obvious warnings of heart disease are often missed.
"While chest pain remains the most common symptom of a heart attack in women, they are more likely than men to experience symptoms beyond chest pain, including shortness of breath, nausea, fatigue, and jaw or neck pain - signs that can be easily dismissed or missed by sufferers, family members, and even healthcare professionals viewing the disease through a gendered lens," she said.
Enter: the HER Health Network – with the acronym signalling its unique focus on Heart, Endocrine and Renal care.
An integrated team of cardiac, renal, and metabolic specialists, working alongside dietitians, exercise physiologists, and clinical psychologists – helping women to tackle drivers of cardiovascular risk like diabetes, obesity, and kidney disease.D r Fiona Foo, a cardiologist who helped establish the HER Network, says poorly integrated care has profound consequences for women of all ages.
She says her earlier advocacy work with the US-founded Go Red for Women campaign helped her recognise that the complex conditions increasing women's risk of heart disease, deserve far greater attention.
"In the last few years, we've seen an explosion in cardio-kidney-metabolic disease, particularly obesity and metabolic syndrome, and we're finding that medications used for kidney disease and diabetes can also help the heart," Dr Foo explains.
The shift toward integrated care was a lightbulb moment for Dr Foo. Based at Macquarie, she reached out to endocrine and kidney specialists, who were seeing the same barriers in women's healthcare.
The conversation moved quickly to collaboration. Working from the same clinic building, with shared systems and close links to Macquarie University Hospital, the specialists had a rare opportunity to build Australia's first dedicated women's cardio-kidney-metabolic team.
Dr Foo says the multidisciplinary approach avoids the pitfalls of what critics call "bikini medicine" - a narrow focus on reproductive and sexual health that often excludes broader, systemic conditions such as heart disease, diabetes, and even renal disease, which can present differently or be under-recognised in women despite affecting both men and women.
Dr Foo says women's cardiovascular risk can be shaped by a range of sex-specific and gender-related factors, including:
- pregnancy-related conditions, such as pre-eclampsia and gestational hypertension
- menopause, including premature or early menopause.
- metabolic conditions, including PMOS, formerly known as PCOS.
- endometriosis
- autoimmune and inflammatory diseases, including rheumatoid arthritis and lupus.
- some breast cancer treatments.
- psychological risk factors, including depression and anxiety.
- social determinants of health, including race, ethnicity, education and income.
- environmental stressors, including air pollution.
"All of these things affect women, but there has been a longstanding assumption that heart disease is a man's disease," says Dr Foo. All of these things affect women, but there's been a longstanding assumption that it's a man's disease."
Members of the HER Health Network at the network launch event (left to right): Professor Veronica Preda, Dr Fiona Foo, Dr Mona Razavian, Dr Catherine Smillie, Associate Professor Amanda Wang and Dr Yu Fang Wu.
Professor Veronica Preda is an endocrinologist at Macquarie University Hospital and another key specialist within the HER Network.
She says that one of the network's greatest strengths lies not only in specialist expertise, but in its ability to create continuity between disciplines that have traditionally worked independently of one another.
"It is a different approach, but it's also about upskilling," explains Professor Preda.
"There has been a significant shift in guidelines in this area. For example, in Australia, Polyendocrine Metabolic Ovarian Syndrome (PMOS) has implications for cardiometabolic disease across the reproductive lifespan, so the goal is to identify it early and ensure continuity of care from the outset."
For Preda, that continuity is critical in addressing the fragmented experience many women face when navigating health conditions across multiple specialists.
"If your colleagues are seeing a certain patient, and then their GP is a key anchor point, it can be very piecemeal. The fragmented care is what we are overcoming as well all work collaboratively together through the lifecycle journey with women's health."
For Dr Foo, however, perhaps one of the biggest challenges remains awareness, not just within medicine, but, as a quick Google search reveals, in the images we collectively associate with a heart attack itself.
"I think females need to realise that heart disease can be more of a problem than issues like breast cancer," says Dr Foo.
"But if you get checked early many of these risk factors are actually preventable."
Women's heart health: what to know and when should I get checked?
Dr Foo says many cardiovascular risks can be reduced if they are identified early.
- Book a Heart Health Check with your GP from around age 45, or earlier if you have diabetes, chronic kidney disease, a strong family history or other risk factors. First Nations people are eligible from age 30.
- Use menopause as a heart health checkpoint, particularly if you have premature or early menopause.
- Know your numbers, including blood pressure, cholesterol, blood glucose, and weight.
- Ask about regular follow-up if you have sex-specific risk factors, including pregnancy-related complications such as pre-eclampsia, gestational hypertension, or gestational diabetes.
- Support the basics of heart health: eat well, stay physically active, avoid nicotine, prioritise sleep and maintain a healthy weight.
- Manage key clinical risk factors, including blood lipids, blood glucose, and blood pressure.
- Look after psychological health, including stress, depression, and anxiety.
- Reduce environmental stressors where possible, including exposure to air pollution.
When should I seek help?
Women should know the warning symptoms of heart disease and seek medical advice if something feels wrong.
- See your GP for assessment if you experience symptoms such as chest pain or discomfort, shortness of breath, dizziness, palpitations, unexplained fatigue, or fainting.
- Call 000 immediately or go to the nearest emergency department if symptoms are sudden or severe, or include chest pain, significant breathing difficulty, or loss of consciousness.
- For women in Sydney seeking specialised support, the HER Clinic provides dedicated, integrated women's health care. To learn more or book an appointment, visit: https://www.mqhealth.org.au/services/find-a-service/her-health-network
- The specialists behind the HER Health Network include cardiologists Dr Fiona Foo and Dr Catherine Smillie; endocrinologists Professor Veronica Preda and Dr Yu Fang Wu; and renal physicians Dr Mona Razavian and Associate Professor Amanda Wang.
