Cardiovascular disease manifests differently in women compared to men, yet medical guidelines often fail to account for these differences due to a history of male-focused research. Biological and social factors intersect to create a unique risk profile for women, requiring a more personalized approach to prevention and treatment.
The genetic difference between men and women—two X chromosomes in women versus one X and one Y in men—extends far beyond reproductive organs. These genetic variations influence how cardiovascular disease develops, which can result in different symptoms and outcomes. While biological sex shapes the underlying mechanisms of heart disease, gender—encompassing social, psychological, and cultural factors—also plays a significant role in how it is recognized and treated by healthcare providers.
Women are more likely to die after a first heart attack or stroke compared to men. They often experience a broader range of symptoms beyond the classic chest pain, including nausea, dizziness, fatigue, and jaw pain. These differences can complicate diagnosis and treatment, making it difficult to fully separate the impact of sex-based biology from gender-driven healthcare experiences.
Prior to menopause, women generally have a lower risk of cardiovascular disease than men. However, after menopause, their risk rises sharply. For women with Type 2 diabetes, the risk of a heart attack matches that of men, even if they haven’t yet experienced menopause. These dynamics are still not fully understood, and more research is needed to explore how heart disease affects nonbinary and transgender individuals.
Despite these differences, cardiovascular disease remains the leading cause of death across all genders. Researchers studying women’s health emphasize the importance of updating medical guidelines to reflect sex-specific factors, aiming to improve outcomes for everyone.
Current medical research has significant gaps when it comes to understanding heart disease in women. Historically, women were not included in clinical studies until the NIH Revitalization Act of 1993, leading to a lack of data tailored to women’s cardiovascular needs. As a result, many guidelines for treating heart disease are based on studies focused primarily on men. For example, blood pressure management recommendations often stem from male-centric research, despite evidence that women’s cardiovascular disease follows different patterns.
Implicit biases in healthcare also play a role. Women’s heart attack symptoms are sometimes attributed to non-cardiac causes, resulting in underdiagnosis and delayed treatment. Providers may be more hesitant to perform invasive tests on women, leading to fewer aggressive diagnostic measures compared to men with similar symptoms. This bias, coupled with gendered social norms, contributes to why women are more likely to die from cardiovascular events.
A study involving approximately 3,000 recent heart attack patients found that women were less likely to associate their symptoms with heart disease than men. This lack of awareness contributes to delays in seeking medical help. Compounding these challenges, many women do not realize that heart disease is their leading health risk. Misconceptions about their own vulnerability often deter them from discussing symptoms with their doctors.
These disparities are even more pronounced among women of color, who face additional barriers to accessing quality healthcare. Socioeconomic factors, cultural stigmas, and historical inequities exacerbate the already significant risks associated with cardiovascular disease in these communities.
Physically, heart disease doesn’t look the same in men and women. In women, plaque buildup in arteries tends to differ, with fewer cholesterol crystals and calcium deposits. This can lead to different presentations of the disease. For example, women are more likely to have smaller blood vessels that narrow but do not completely block, causing persistent chest pain without the typical arterial blockages. This condition, called ischemia with no obstructive coronary arteries (INOCA), is often harder to diagnose and treat compared to the more straightforward “clogged” arteries often seen in men.
Traditional diagnostic tools, like stents or bypass surgery, are designed to treat the typical blockages found in men. This leaves women at a disadvantage when their condition doesn’t fit the classic patterns. Another complicating factor is that blood tests used to detect heart damage during the early stages of a heart attack may show lower levels of indicators in women, leading to more missed diagnoses.
Researchers are still exploring the reasons behind these differences. Possible factors include variations in plaque composition, with men’s plaques more likely to rupture and women’s more likely to erode. Additionally, women generally have smaller heart mass and narrower arteries, even when body size is accounted for.
Addressing these disparities requires a shift in medical practice. Women presenting symptoms of heart disease are often dismissed due to biases that suggest they are at lower risk than men. Recognizing the different ways that cardiovascular disease can present across genders could enhance diagnostic accuracy and improve treatment for all.
One promising change is the introduction of sex-specific criteria for blood tests that detect heart damage. High-sensitivity troponin tests can be adjusted to account for biological differences, reducing missed diagnoses in women and unnecessary procedures in men. This tailored approach is a step toward closing the gap in cardiovascular care.
Ongoing research aims to better understand sex-specific symptoms and create more targeted treatments. Efforts at institutions like the Ludeman Family Center for Women’s Health Research at the University of Colorado focus on expanding knowledge and refining medical guidelines to benefit all patients. There is also growing momentum from government initiatives, such as recent executive orders that prioritize women’s health research. These measures support a more inclusive and nuanced understanding of cardiovascular disease, encouraging healthcare systems to adopt approaches that address individual patient needs.
By acknowledging and acting on these differences, the medical community can move toward better, more equitable heart care for everyone, regardless of gender or biological sex.