The finding that Pakistani women have the highest death rate from ischaemic heart disease among women in five South Asian countries should serve as a serious warning for both health policymakers and the public. It challenges the long-standing perception that cardiovascular disease is primarily a man’s disease and highlights an urgent but often overlooked threat to women’s health.
The issue came into sharper focus on the eve of World Heart Day on September 29, when cardiologists, gynaecologists and representatives of the local healthcare industry gathered at the Karachi Press Club to launch the nationwide “Her Heart Matters” campaign. The initiative highlighted evidence from Global Burden of Disease estimates published in JACC: Asia, drawing attention to the growing cardiovascular risks faced by Pakistani women.
According to the study, Pakistan was the only one of the five South Asian countries examined where the ratio of deaths to estimated cases was higher among women than men. The ratio stood at 4.4 percent for women compared with 3.1 percent for men. Whatever the limitations of such estimates, the finding is significant because it points to a serious gap between the prevalence of cardiovascular risk and the ability of the healthcare system to identify and manage it in time.
Heart disease is still widely perceived in Pakistan as an illness that primarily affects men, particularly older men. That perception can have serious consequences. When women, their families and even healthcare providers do not immediately associate certain symptoms or risk factors with cardiovascular disease, diagnosis can be delayed until the condition has become much more difficult to treat.
The major risk factors are hardly unknown. Hypertension, diabetes, obesity, physical inactivity and unhealthy diets are all well-established contributors to cardiovascular disease. The problem is that awareness of these risks does not necessarily translate into regular screening, preventive treatment or sustained follow-up.
As a result, many women reach hospitals only after significant complications have developed. By then, the opportunity to prevent or delay serious cardiovascular disease may already have been lost.
There is also a need to rethink how women’s healthcare is approached throughout their lives. Cardiovascular health should not become a concern only after middle age or when symptoms become severe. Certain stages of a woman’s life can provide important opportunities for identifying cardiovascular risks much earlier.
Pregnancy and childbirth, for example, can reveal underlying health problems that may have implications well beyond the pregnancy itself. High blood pressure during pregnancy should not simply be treated as a temporary condition that ends with delivery. Women who experience pregnancy-related hypertension require appropriate follow-up because it can indicate a higher future risk of cardiovascular disease.
Women already living with diabetes, obesity or hypertension require even greater attention. These conditions frequently overlap and can significantly increase cardiovascular risk. The experience of major public hospitals, where many women seeking treatment for diabetes also present with one or more cardiovascular risk factors, demonstrates how closely these conditions are connected.
This makes routine screening particularly important. A woman should not have to wait for chest pain, breathlessness or another severe symptom before her cardiovascular health is assessed. Prevention depends on identifying risk before disease becomes an emergency.
But changing public perceptions is only one part of the solution. Pakistan’s healthcare system also needs to strengthen its primary and secondary levels of cardiovascular care. Tertiary cardiac hospitals perform an essential function, but they cannot be expected to carry the entire burden of cardiovascular disease.
A patient who develops hypertension should ideally be diagnosed and managed at the primary-care level. A woman with diabetes or obesity should have her cardiovascular risk assessed during routine treatment. Patients requiring specialist intervention should then be referred appropriately. Such a system would reduce pressure on major hospitals while allowing serious conditions to be identified earlier.
The alternative is an increasingly expensive cycle in which patients receive care only after their condition has deteriorated. Emergency treatment is inevitably more costly, more difficult and often less successful than prevention and early intervention.
Families also have an important role to play. Women frequently carry substantial responsibilities for children, elderly relatives and household management, leaving their own health needs at the bottom of the priority list. This attitude must change.
Women need the time and support to attend medical appointments, undergo screening, remain physically active and follow prescribed treatment. A woman who postpones medical care because of household responsibilities is not merely making an individual choice; she is often responding to expectations about whose health should take priority within the family.
The “Her Heart Matters” campaign is therefore timely and potentially valuable. But its real success should not be measured by the number of seminars, awareness sessions or media messages generated around World Heart Day. The more meaningful measure will be whether awareness translates into behaviour and healthcare outcomes.
Are more women being screened for hypertension and diabetes? Are high-risk women being identified earlier? Are women receiving proper follow-up after pregnancy-related hypertension? Are patients able to access affordable medicines and specialist care when required? These are the questions that will determine whether awareness efforts produce lasting change.
Pakistan cannot afford to treat cardiovascular disease among women as a secondary health issue. The evidence suggests that the risks are substantial, while gaps in prevention and early diagnosis remain considerable.
The country therefore needs a broader approach that combines public awareness with accessible primary healthcare, routine screening, better referral systems and sustained follow-up. Doctors, families, schools, workplaces, communities and policymakers all have a role in creating an environment in which women can take their cardiovascular health seriously.
Most importantly, prevention must begin before the emergency ward. By the time a woman arrives at a cardiac hospital with a serious complication, the healthcare system has already missed several opportunities to intervene. The real goal should be to identify risk years earlier, manage it consistently and prevent disease from reaching that point.
Women’s heart health is not simply a medical issue. It is a question of family wellbeing, economic productivity and the quality of life of millions of Pakistani women. The message behind “Her Heart Matters” is therefore worth extending beyond a campaign: her heart matters every day, and prevention must start long before a crisis begins.