Women’s heart health: closing the gaps in research, advancing earlier detection and personalized cardiac care

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in women worldwide, yet women’s cardiovascular health remains substantially underrecognized, underdiagnosed, undertreated and understudied compared with men’s cardiovascular health [1]. This gap is shaped by historical biases in medical knowledge, limited sex-specific clinical training, underrepresentation in research and diagnostic approaches largely based on male data. The result can be delayed diagnosis, fewer interventions and worse outcomes following cardiovascular events. Improving women’s heart health requires a deliberate shift toward female-inclusive, female-informed care—one that better reflects women’s anatomy, physiology, risk factors and life stages.

CVD accounts for nearly two-thirds of all female deaths in some European countries, [2] and its global burden among women increased by 74% between 1990 and 2019.[3] In the United States, 44% of women live with some form of heart disease. [4] Women also have a cardiovascular risk profile that differs from men’s. Traditional risk factors such as hypertension, high cholesterol, diabetes, obesity, smoking and physical inactivity affect both sexes, but can accumulate earlier and lead to greater adverse consequences in women. [5] In addition, women may face sex-specific risk factors throughout their lives, including pregnancy-related complications, early menopause, polycystic ovary syndrome, endometriosis, some breast cancer treatments and autoimmune disease. Pregnancy is an especially important window into long-term cardiovascular health. Hypertensive disorders of pregnancy, gestational diabetes and peripartum cardiomyopathy can be predictors of future CVD. A life-course approach can help connect pregnancy-related health events with appropriate cardiovascular follow-up and long-term monitoring.

Women can experience and report cardiovascular symptoms differently from men. While men often present with classical chest pain, women may describe fatigue, nausea, dizziness, shortness of breath or back pain.[7] These symptoms can be overlooked or attributed to noncardiac causes, contributing to delays in diagnosis. Women's hearts are structurally and functionally different from men’s hearts in ways that fundamentally affect disease presentation and diagnosis. Women’s hearts are approximately 10–15% smaller than men’s hearts. [6] Beyond size, women have distinct coronary vasculature, with different microvascular function, endothelial properties, and unique structural geometry compared to men. These distinctions can affect disease presentation and diagnostic accuracy. Women more frequently experience diffuse, non-obstructive plaque patterns affecting the small blood vessels of the heart. Important conditions and syndromes include:

These conditions can be difficult to identify using approaches developed primarily to detect large-artery obstruction.

Standard cardiac ultrasound measurements were developed and validated largely in male populations and may not apply validly to women. [8] Factors including user dependency, demographic variation and sex-specific technical differences can affect interpretation.

Women are often engaged with healthcare services before conception, during pregnancy and throughout the postpartum period—often before they enter a traditional cardiology pathway. This creates an opportunity to connect maternal health and cardiovascular care more intentionally. Potential areas of focus include:

A connected approach could help reduce fragmentation between maternal health events and future cardiovascular care.

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