- T Truong, researcher1,
- M Ahmed, researcher1,
- K Gamayata, consultant2,
- T Arachi, consultant3
- 1University of Oxford, Oxford, UK
- 2Manchester Metropolitan University, Manchester, UK
- 3Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Correspondence to: T Truong tiffany.truong{at}seh.ox.ac.uk
More than 109 million women globally are living with heart and circulatory disease,1 yet they are more likely than men to be underdiagnosed, undertreated, and under-represented in research trials.2 This persistent gender gap is more than a clinical shortcoming; it is a deeper structural failure in health policy. Women are projected to continue to have more disability adjusted life years attributable to cardiovascular risk factors than men,3 and more deaths from rheumatic heart diseases.4 True equity in cardiovascular outcomes can be achieved only if we recognise biological sex (the physiological and chromosomal differences) and gender (the sociocultural norms and expectations) as fundamental determinants in health policy, system design, and guidelines.
From the onset of symptoms to long term management, women consistently face systemic delays in cardiovascular care.5 A 2025 cohort study found that 64% of women with acute coronary syndrome attributed their chest pain to non-cardiac causes, such as anxiety or reflux, and only 35% sought care after complications occurred.6 A study of outcomes after myocardial infarction shows that clinicians make similar misjudgements: 53% of women were initially told their symptoms …
