Marlies Alvarenga: Balancing the Scales in Women’s Cardiovascular Health

Marlies Alvarenga, Senior Lecturer in Clinical Psychology at Federation University Australia and Adjunct Senior Lecturer at the Monash University School of Public Health and Preventive Medicine, shared a post on LinkedIn:

“On International Women’s Day, I think of the women I have met in clinics, in classrooms, and in conflict zones. I think of their endurance, their intelligence, resilience and their quiet, relentless capacity to hold families and communities together.

Women do not simply contribute to progress; they carry it. When women rise, entire societies steady themselves.  However, I have also learned that admiration is not enough. In women’s cardiovascular health, sentiment without structural change costs lives.

Cardiovascular disease remains the leading cause of death among women globally. Yet for decades, the science that guides diagnosis and treatment has leaned heavily on male patterns of disease. Yes, women’s hearts have too often been measured against a template that was never designed for them.  Women’s symptoms have been minimised, their risks underestimated, and their biological transitions under-integrated into mainstream cardiology.

Pregnancy complications such as preeclampsia and gestational hypertension are still too often treated as isolated events rather than early warnings of long-term vascular vulnerability. Menopause, often framed as a private inconvenience rather than a cardiovascular turning point, alters lipid metabolism and autonomic balance at precisely the stage of life when many women are caring for ageing parents, supporting adult children, or re-entering the workforce. This is why this year’s theme, ”Balance the Scales”, feels urgent to me. The scales are not abstract; they are tipped in research agendas, in funding priorities, in access to care, and in the everyday safety of women’s lives.

A woman’s heart is shaped not only by physiology, but by the conditions in which she lives. It is shaped by whether she was able to remain in school, whether she has the knowledge to question and interpret health information, whether she feels safe enough to trust without fear, and whether her body has been treated with dignity and respect.

Education is one of the most powerful forms of protection I have witnessed. An educated girl grows into a woman who can question dangerous trends, resist manipulative marketing, and recognise when her body is signalling distress. In many communities, I see women targeted with social media forcefully pushing unregulated supplements, stimulant-based appetite suppressants and so-called “detox” products. These are sold as empowerment. Yet they can destabilise blood pressure, disturb electrolytes, trigger arrhythmias and precipitate acute cardiac events. True empowerment is not self-punishment, it is informed choice.

A woman who understands her body is more likely to nourish it well, move it regularly, rest it adequately and seek care early. These are not cosmetic acts. They are cardioprotective behaviours that accumulate over a lifetime.

A sense of safety is equally important.

At this moment, as armed conflicts intensify in parts of our world, women are once again disproportionately exposed to harm. Displacement affects healthcare access. Food and housing insecurity become daily realities. Sexual violence and exploitation increase in instability. Even in settings untouched by war, many women live with coercive control, objectification and chronic relational uncertainty.  These experiences leave biological traces.  Persistent stress activates the hypothalamic–pituitary–adrenal axis and the sympathetic nervous system, raising blood pressure, amplifying inflammation and disrupting metabolic regulation. Trauma reshapes autonomic balance and sleep patterns. Depression and anxiety, which affect women globally at nearly twice the rate of men, are associated with significantly increased risk of cardiac events and mortality, highlighting that the burden of social inequality ultimately manifests in biology.

If we are sincere about balancing the scales, we must understand that peace, protection and education are cardiovascular interventions. When a woman feels safe, her nervous system settles. When she is educated, her health decisions strengthen her long-term prognosis. When she is supported, her quality of life improves, and so does her ability to work, to care, to lead, to love and to rebuild.

To balance the scales, health systems need to be more sex-specific and trauma-informed. Reproductive history must be part of cardiovascular risk assessment. Psychosocial screening should be standard within cardiology services and, definitely, part of cardiac treatment. Mental health support is not an optional extra; it is essential care.

Women living in conflict settings or economic disadvantage must retain uninterrupted access to screening, medication and preventive services. Technologies need to be accessible and affordable in difficult-to-reach places, such as remote communities, to increase access to education and healthcare for the most vulnerable. Clinicians, public health leaders, educators, social scientists and policymakers must work collaboratively, setting aside professional ego in favour of shared purpose, recognising that complex health challenges are best addressed through collective expertise. Research must reflect the lived realities of women across adolescence, reproductive years and later life. Depression, anxiety and social support (or lack thereof) must be routinely assessed in cardiac settings to ensure better treatment adherence, cardiac outcomes, and improve quality of life.

When women are healthy, they are not merely surviving; they are building. They cultivate families, strengthen economies, sustain institutions and create solutions. Their productivity flows from their well-being.

On this International Women’s Day, ”Balance the Scales” calls us to more than acknowledgement. It calls us to even out the scales as an act of humanity. Protecting women’s hearts protects the stability and future of our communities. And that is not only a medical priority, it is a moral one.”

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