Cardiovascular disease is the leading cause of death in women worldwide. Despite improvements in awareness on heart disease in women through various campaigns and initiatives, cardiovascular risk in women still tends to be underestimated by health care professionals and women themselves. With respect to the latter, a study from the United States has even shown a decline in awareness regarding the fact that heart disease is the leading cause of death among women over recent years. Especially young women are affected by low awareness about cardiovascular risk as confirmed by the data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, which also found that women are less likely than men to have a discussion about their cardiovascular risk and potential risk modification with their health care provider. Health care providers’ preparedness to assess women’s cardiovascular risk appears to be suboptimal, and according to survey data the majority of primary care physicians and cardiologists do not comprehensively implement cardiovascular disease prevention guidelines in women. Accurate and timely diagnosis of various cardiovascular diseases, especially ischemic heart disease, are less frequent in women compared with men. In addition, women with established cardiovascular disease have repeatedly been documented to be less likely to receive guideline-recommended therapies. ^, Sex-related differences in disease presentation and comorbidities may contribute to these disparities, and uncertainties persist with respect to diagnosis and treatment of certain disease states that disproportionally affect women (e.g. ischemia with non-obstructive coronary arteries [INOCA], myocardial infarction in the absence of obstructive coronary artery disease [MINOCA], spontaneous coronary artery dissection [SCAD], and takotsubo syndrome).

One of the major issues is the lack of robust study data on cardiovascular disease in women. Women remain underrepresented in the majority of cardiovascular clinical trials, and sex-specific study data reporting is often absent, which results in uncertainty about the safety and efficacy of many cardiovascular therapies. In addition, it leads to knowledge gaps in the sex-specific pathophysiological mechanisms and the natural history of cardiovascular disease in women.

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