Show me:
Show me:
When doing nothing does harm
heartfoundation.org.au|Helpline 13 11 12

When doing nothing does harm

Women's Health Week guest blog written by National Heart Foundation of Australia Group CEO Adj Prof John G Kelly AM.

Do no harm. This injunction and its modern variants are among the most basic tenets of the Hippocratic oath that doctors take when they start out in medicine. But what happens when a treatment that saves lives through treating one disease increases the risk of patients becoming ill, or even dying, of another? And what if this process has the potential to disproportionately affect one sector of society, one sex?

As Australia heads into Women’s Health Week, these questions reverberate not just for what they tell us about the assumptions and inequities that still underpin our society, and our medicine, but also for what they tell us about what we must do to improve – and save – women’s lives, starting now.

It’s a challenge the Heart Foundation is tackling on several fronts, most recently through a major investment in research designed to plug gaps in our understanding of the prevention and treatment of heart disease, with a particular focus on women. More on that in a minute.

But first, let’s talk about cancer.

This year, an estimated 145,483 new cases of cancer will be diagnosed in Australia. Fortunately, an increasing number of these patients will survive due in part to advances in treatment. Australia now has one of the highest rates of cancer survival in the world. Yet at the same time, a growing number of cancer survivors are going on to die of heart disease.

This pattern is not unique to Australia. A recent paper from the European Society of Cardiology describes “a growing epidemic of cardiovascular disease” in patients during and after cancer treatment. International studies have shown that cancer patients are up to 15 times more likely than those without a history of cancer to develop heart disease.

The reasons are intertwined, and derive in part from ageing populations and overlapping risk factors (including obesity and smoking) for the two conditions. But for a significant number of cancer patients, the treatment itself will leave a potentially lethal legacy.

Intensive cancer regimens, including types of chemotherapy, immunotherapy and radiotherapy, can damage the heart muscle and valves as well as blood vessels. This collateral damage can lead to heart failure and premature death in people with and without a history of heart disease, and is the focus of the emerging field of cardio-oncology.

Paradoxically, a recent Australian study, partly funded through a Heart Foundation research grant, found that cancer patients and survivors are less likely than people without a history of cancer to be taking drugs to prevent blood clots or treat high cholesterol – despite being at similar risk of heart disease and stroke.

What does all this have to do with women?

There is evidence that women may be at particular risk from cardiotoxic treatments. Studies show that women who had cancer as children are at greater risk than men of going on to develop conditions including heart failure. Women exposed to ionising radiation during therapy for breast cancer may have an increased risk of heart attack or heart disease later in life, according to some studies.

We know too that a sustained focus on, and investment in, the treatment of breast cancer has resulted in many more women now surviving that disease.  

Sadly, the same cannot be said of women with heart disease, which kills more than twice as many women as breast cancer does, but which has traditionally been seen as a male problem.

Underpinning all this is the fact that gender disparities in research, prevention, diagnosis and treatment mean that heart disease in women is less well understood and treated than in men. Not only are many of our assumptions based on male data and physiology, but women are less likely to receive in-hospital therapies and ongoing treatment.

This is a global problem, but it has particular resonance here in Australia, where a 2019 report in the Medical Journal of Australia noted that medical research in Australia now lags behind North America and Europe in recognising sex and gender as “key determinants of health”.

In June, the Heart Foundation and Federal Government jointly announced $8 million for cutting-edge research into Australia’s biggest killers, heart disease and stroke, an initiative that will benefit all Australians while working to redress these sex and gender biases. The strategic grants focus on four emerging fields of cardiovascular research, and include $2 million to bring cardiologists and oncologists together to collaborate on preventing and treating heart disease in cancer survivors.

Two other projects will in turn focus on predictive modelling to help accurately predict individual risk, and secondary prevention, such as supporting patients to attend cardiac rehabilitation – both areas in which women have been underrepresented. The fourth project focuses directly on women and heart disease, aiming to address sex and gender-based disparities in treatment and care.

As I’ve said before, we are still a long way from heart health equality. We have work to do, including overturning some entrenched beliefs. But doing nothing is not an option.

If you would like to help the Heart Foundation further address such inequities donate now.

For the women you love.

You might also be interested in

Women's heart stories

Women's heart stories

Women's heart stories

Women's stories from around Australia...

Heart disease and pregnancy

Heart disease and pregnancy

Heart disease and pregnancy

Pregnancy is often referred to as the “ultimate stress test” for the body....

Heart Age Calculator

Heart Age Calculator

Heart Age Calculator

Could you be at risk of heart disease? Get your estimated heart age now....

Cardiovascular disease risk factors and heart attack warning signs in women

Cardiovascular disease risk factors and heart attack warning signs in women

Cardiovascular disease risk factors and heart attack warning signs in women

Information for healthcare professionals and the public on cardiovascular disease risk factors and warning signs affecting women. ...

Women and heart disease

Women and heart disease

Women and heart disease

Information on women and heart disease for consumers....

Heart Week 2022

Heart Week 2022

Heart Week 2022

With one Australian having a heart attack or stroke every 4 minutes, you have the power to change this statistic. ...

Health Professional Tools

Health Professional Tools

Health Professional Tools

Guidelines, publications and support for the health professional community....

Time to book a Heart Health Check?

Time to book a Heart Health Check?

Time to book a Heart Health Check?

If you're 45 and over, or 30 and over if you're of Aboriginal or Torres Strait Islander descent, you should book your Heart Health Check today...

Together, we can change the future of heart disease

Together, we can change the future of heart disease

Together, we can change the future of heart disease

The power of your ongoing support can help save lives and keep more families together. Help us continue to fund promising heart research projects by donating today. ...

Heart Health Check Toolkit

Heart Health Check Toolkit

What is acute rheumatic fever and rheumatic heart disease?

What is acute rheumatic fever and rheumatic heart disease?

What is acute rheumatic fever and rheumatic heart disease?

Rheumatic heart disease is a serious disease that causes damage to your heart valves. ...

Using big data to inform post-hospital treatment decisions with cardiovascular medicines

Using big data to inform post-hospital treatment decisions with cardiovascular medicines

Dr Michael Falster, Institution: University of New South Wales...

Cheesy Mexican vegetable pie

Cheesy Mexican vegetable pie

Cheesy Mexican vegetable pie

1 hour
Serves 4

Feelings and emotions after a heart attack

Feelings and emotions after a heart attack

Feelings and emotions after a heart attack

This is a guide to how you might be feeling after a heart attack. ...

Taking your heart medicines

Taking your heart medicines

Taking your heart medicines

Know what your heart medicines are for and how to take them. ...

For professionals: Aboriginal and Torres Strait Islander peoples identification training

For professionals: Aboriginal and Torres Strait Islander peoples identification training

Asking the Question of Origin course helps with identification of Aboriginal and Torres Strait Islander patients, in line with standard practice.  ...

Being a carer for a heart attack patient

Being a carer for a heart attack patient

Being a carer for a heart attack patient

Your role as a carer for a heart attack patient is an important one – explore some useful things to know....

Heart Health Network

Heart Health Network

Heart Health Network

Sign up for the latest news, guidelines, practical resources and opportunities curated by the Heart Foundation for health professionals ...

Donate to the Heart Foundation

Donate to the Heart Foundation

Donate to the Heart Foundation

Every dollar that you donate will help fund research, support and programs that help save lives....

Action Plans

Action Plans

Action Plans

Recovery is a long journey, so having a plan makes a huge difference. Using an action plan gives you a step-by-step guide to improving your lifestyle....

Heart stories

Heart stories

Heart stories

Stories of hope from Australian men and women fighting heart disease....

Driving Best Practice CVD Prevention in a Post-COVID World

Driving Best Practice CVD Prevention in a Post-COVID World

Driving Best Practice CVD Prevention in a Post-COVID World

Heart Foundation Research Award Recipients

Heart Foundation Research Award Recipients

Explore our research award recipients and projects...

Nutrition after a heart attack

Nutrition after a heart attack

Nutrition after a heart attack

Discover key information on heart-healthy eating and drinking....

Q&A with Dr Eleanor Quested

Q&A with Dr Eleanor Quested

Q&A with Dr Eleanor Quested

Harnessing the appeal of professional sport to improve health for men with cardiovascular disease...

What is heart failure?

What is heart failure?

What is heart failure?

Heart failure is a condition where your heart isn’t pumping as well as it should be....

Baking recipes

Baking recipes

Baking recipes

Find heart healthy baking recipes ...

For professionals: Guidelines for acute rheumatic fever and rheumatic heart disease

For professionals: Guidelines for acute rheumatic fever and rheumatic heart disease

Australian  guidelines  for  prevention, diagnosis and  management of  acute  rheumatic  fever and  rheumatic  heart  disease ...

WEBINAR | Navigating the latest updates on CVD prevention

WEBINAR | Navigating the latest updates on CVD prevention

ACE2 and cardiac events after severe COVID-19 infection

ACE2 and cardiac events after severe COVID-19 infection

Professor Louise Burrell, Institution: The University of Melbourne...

Heart failure clinical resources

Heart failure clinical resources

Resources and clinical information for health professionals...

Optical pacing of the heart

Optical pacing of the heart

Dr Damia Mawad. Institution: University of New South Wales...

Heart Week

Heart Week

How to make healthier meals at home

How to make healthier meals at home

How to make healthier meals at home

Cooking at home is often healthier than eating out....

Clinical resources: Coronary heart disease and mental health

Clinical resources: Coronary heart disease and mental health

The prevalence of depression is high in patients with coronary heart disease (CHD)....