Introduction

Globally, cardiovascular disease (CVD) is the leading cause of death in women. However, the misconception that it is a ‘man’s disease’ underlines that CVD in women has contributed to its under-recognition and undertreatment. Over 3.6 million women in the UK are currently affected by ischaemic heart disease, which kills one in 14 women. Approximately 30% of the total 81 765 myocardial infarctions (MI) registered in the UK between 2022 and 2023 occurred in women. A discrepancy between women and men in the proportion of patients admitted with higher-risk ST-segment elevation myocardial infarction (STEMI) not receiving reperfusion treatment has been reported, and this phenomenon occurs more frequently in older women. The possible reasons might include delayed access to the emergency care compared with men secondary to lack of awareness, underestimated risk and social barriers. In addition, a lower proportion of women admitted with lower-risk non-ST segment elevation myocardial infarction (NSTEMI) receive angiography within 72 hours compared with men. In addition, women are under-represented in cardiovascular clinical research, meaning that many treatments are mainly investigated in men and then applied to women, with the expectation that sex-based differences in physiology and pharmacokinetics will have little impact. Even where prognostic cardiovascular therapies are well established, women are frequently under-referred for treatment which leads to poorer outcomes (figure 1).

Figure 1 Main factors contributing to sex differences across different subareas of cardiovascular disease. ACHD, adult congenital heart defects; ACS, acute coronary syndrome; CAC, coronary artery calcium; CAD, coronary artery disease; CPRPs, cardiovascular prevention and rehabilitation programmes; CRT, cardiac resynchronisation therapy; CV, cardiovascular; DCM, dilated cardiomyopathy; GDMT, guideline-directed medical therapy; HCM, hypertrophic cardiomyopathy; HER2, human epidermal growth factor receptor 2; HF, heart failure; HVD, heart valve disease; ICD, implantable cardiac defibrillator; LQT, long QT; LV, left ventricular; MACE, major adverse cardiovascular events; MVA, microvascular angina; SCAD, spontaneous coronary artery dissection; SCD, sudden cardiac death; TdP, torsades de pointes; VAD, ventricular assist device.

This consensus document put together by representatives from each of the leading UK cardiovascular affiliated societies including the Primary Care Cardiovascular Society, nursing and patient affiliated societies, outlines the key sex-specific differences across the CVD spectrum and the recommendations for addressing cardiovascular health inequalities among women in the UK (figure 2). The terms sex and gender are closely related to each other, and they are often identified as the same erroneously. According to the WHO, sex refers to the biological characteristics that define humans as female or male such as chromosomes, hormones and reproductive organs, while gender refers to the socially constructed roles comprehensive of norms and behaviours associated, as well as relationships. The main purpose of this document is to advance the access to diagnosis and treatment among women suffering from CVD with provision of disease-specific action points to be implemented by all affiliated societies, mostly referring to a sex-based approach since the pathophysiological differences in CVD are driven by biological sex and the associated reproductive organs/hormones (tables 1–3). However, we recognise that a gender-based perspective would be helpful to explore and call attention to acquired risk factors secondary to personal choices, hormonal fluctuation and social/physical relationships. Gender is a wider concept which can vary across different cultures and over time. We hope this document will help improve the care of women with CVD worldwide.

Figure 2 Factors influencing women’s heart health and strategies to overcome sex disparities in cardiovascular care. CV, cardiovascular; CVDs, cardiovascular diseases; MDT, multidisciplinary team; NHS, National Health Service.