Introduction: Why closing the gender gap in heart disease matters
Cardiovascular disease remains the leading cause of death for women worldwide, yet recognition, diagnosis, and treatment for women with heart disease lag behind that for men. The legacy of sex bias—echoed by clinicians and researchers for decades—has translated into under-recognition of symptoms, delayed diagnosis, and less aggressive management for women. The issue is not only biological; gender-related factors, including socio-economic status, access to care, and health literacy, intertwine with pathophysiology to influence outcomes.
What the recent evidence shows about STEMI treatment by sex
Recent analyses from Australia illuminate persistent sex-based differences in the management of ST-elevation myocardial infarction (STEMI). In New South Wales hospitals, women presenting with STEMI tended to be older, had more comorbidities, and were more likely to live in socio-economically disadvantaged areas. They were also less likely to receive timely angiography, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). Consequently, women faced higher rates of major adverse cardiovascular events and mortality during the 12 months after admission. While both sexes benefited from increased use of invasive procedures during 2011–2020, the rise was more pronounced for women, suggesting a degree of encroaching equity, albeit slowly.
These findings align with international data showing that women with STEMI often receive less guideline-directed preventive therapy and have poorer outcomes. The reasons are complex and multifactorial, including older age at presentation, greater comorbidity, a higher incidence of myocardial infarction with non-obstructed coronary arteries (MINOCA), and spontaneous coronary artery dissection more common in women. Although the retrospective design limits causal inference, the associations are consistent and clinically meaningful.
Why differences persist—and what can change
The gender gap is not solely about biology. It reflects structural and societal factors: delayed symptom recognition in women, atypical presentations, unequal access to care, and potential biases in the healthcare system. The current data suggest some progress: treatment rates for both sexes increased over the decade, with a relatively faster improvement among women. Yet the gap in 12-month outcomes remains, underscoring that progress must be accelerated if we are to truly close the gender heart gap.
Research suggests several pathways to faster convergence. First, heightened awareness among clinicians about sex-specific presentations and risk factors is essential. Educational initiatives should emphasize that women may present with different symptom patterns and that age alone is insufficient to gauge risk. Second, standardized STEMI pathways must ensure timely diagnostics and decisive revascularization when indicated, without gender-based delays. Third, policy and system-level changes—such as equitable access to care, targeted public health messaging, and support for women with higher baseline risk due to comorbidities—can help reduce disparities. Finally, robust data collection and prospective studies focused on sex and gender differences are needed to tailor guidelines and assess progress accurately.
What this means for patients, clinicians, and policymakers
For patients, especially women at higher risk, the message is clear: know the symptoms, advocate for timely evaluation, and seek care promptly when heart attack symptoms occur. Providers must adopt sex-informed practice, delivering evidence-based therapies without bias and recognizing that prevention and treatment gaps can have lasting consequences. Policymakers and health system leaders should prioritize equity in cardiovascular care, fund sex-disaggregated research, and monitor metrics that reveal progress or persistent gaps.
A hopeful trajectory—and the work ahead
The evidence from Australia indicates a narrowing gap in invasive treatment and mortality for women with STEMI, offering a blueprint for other regions. While the improvements are encouraging, the pace is insufficient to eliminate disparities in a timely fashion. If the gap is to close more rapidly, a concerted effort from clinicians, researchers, and health systems is essential. By translating sex-specific insights into practice, we can ensure that women receive the same quality of care as men and reduce the burden of heart disease on all patients.
Conclusion
Closing the gender gap in the diagnosis and treatment of heart disease requires sustained commitment to equity, rigorous research, and a patient-centered approach that acknowledges sex and gender as central to cardiovascular care. The journey toward parity is ongoing, but with deliberate action, the future of heart disease care can be more inclusive and outcomes can improve for women and men alike.
