Addressing Gender Bias in Cardiovascular Disease Care for Women

February is Women’s Heart Month, a time dedicated to raising awareness about cardiovascular disease (CVD), the leading cause of death among women globally. While public health campaigns have made significant strides in increasing awareness, one area that remains critically overlooked is the persistent gender bias in the diagnosis, prevention and treatment of CVD in women. A recent systematic review titled “Gender Bias in Diagnosis, Prevention, and Treatment of Cardiovascular Diseases” sheds light on the stark disparities women continue to face in cardiovascular care.

Women Are Underdiagnosed and Undertreated for Cardiovascular Disease

CVD, often thought of as a “man’s disease,” has long been underdiagnosed in women. A key finding from the systematic review is that women are less likely to be diagnosed with CVD compared to men, even when presenting with similar symptoms. This bias stems from a combination of historical misconceptions, atypical symptom presentation in women and a tendency in clinical settings to attribute women’s symptoms to non-cardiac causes such as anxiety, stress or GI symptoms.

Symptoms of heart attacks, for example, often present differently in women than in men. While men frequently experience the classic “crushing chest pain,” women may report more subtle symptoms such as fatigue, shortness of breath, nausea or jaw pain. These variations make care for women a bit more nuanced for healthcare providers, leading to delays in diagnosis and treatment. According to the review, this delay significantly increases the risk of worse outcomes, including higher rates of mortality and complications.

Gaps in Preventive Care for Women

Prevention is one of the most critical components of cardiovascular health, yet women continue to face barriers in receiving appropriate preventive care. Multiple studies have shed light on the fact that women are less likely than men to be prescribed medications such as statins or aspirin, both of which are essential in reducing the risk of cardiovascular mortality. Additionally, women are less frequently referred for lifestyle interventions such as cardiac rehabilitation or counseling for smoking cessation, despite evidence that such interventions are highly effective.

One reason for this gap is that many preventive guidelines have been based on research conducted predominantly in men. Women-specific risk factors — including pregnancy-related complications (preeclampsia, gestational diabetes), early menopause, and autoimmune diseases like lupus — are often overlooked. The future of cardiovascular care for women needs to focus on gender-specific guidelines and screening tools that better account for these risk factors, ensuring that women receive the preventive care they need.

Gender Disparities in Treatment

Even when diagnosed with CVD, women are less likely to receive aggressive treatment compared to men. Women are less often referred for procedures such as coronary angiography or bypass surgery, even when such interventions are medically warranted. In some cases, this may be due to the perception that women’s disease is less severe or that women may not benefit as much from invasive procedures.

However, research shows that when women do receive appropriate interventions, their outcomes are often comparable to men’s. Therefore, the underutilization of these treatments represents a significant missed opportunity to improve women’s cardiovascular health in those with previously diagnosed disease. Additionally, some of our most prescribed cardiovascular medications were studied specifically in men and may not benefit women in the same way or at the same dosage.

The Way Forward: A Call for Gender-Sensitive Care

There is an urgent need for a paradigm shift in how cardiovascular care is delivered to women. First and foremost, healthcare providers must be educated on the gender differences in CVD presentation and progression. A more nuanced understanding of how women experience heart disease and how to identify female specific risk factors can help reduce diagnostic delays in care and ensure timely treatment.

Additionally, there is a pressing need for more research that focuses specifically on women. Clinical trials that include more women participants can provide the data necessary to create tailored guidelines for women’s cardiovascular care. Furthermore, healthcare systems must ensure that preventive care and treatment options are equitable. Women should be provided the same access to life-saving interventions and medications as men, and careful consideration must be given to gender-specific factors that influence cardiovascular risk and treatment outcomes.

Conclusion

As we observe Women’s Heart Month, it’s important to remember that gender bias in cardiovascular care is not just a matter of oversight — it’s a critical health equity issue. We must continue to fight for representation in medical research and public health awareness of the subtle differences in the presentation of cardiovascular disease in women.

See Dr. Amy’s Heart Talk HERE