Even in modern cardiology practice, women with myocardial infarction (MI) across Europe as well as elsewhere continue to face systemic barriers to timely diagnosis and care, compounded by underrepresentation in cardiovascular research historically conducted in male-dominated cohorts.(1) Notably, atypical symptom presentation may also delay recognition and leads to misdiagnosis, further widening the gap in outcomes. Despite advances in cardiology, awareness among patients and caregivers about these gender-specific challenges remains inadequate. We thus welcome the timely publication in the European Journal of Preventive Cardiology of a landmark cohort study including all MI admissions aged 45-80 years across Scotland between 2010–2016.(2)
Biological differences, such as hormonal influences and conditions like pregnancy-associated MI, contribute to unique risk profiles in women. Social determinants like socioeconomic disparities, particularly in regions with fragmented healthcare systems, hinder access to timely care. As evidenced by Pana et al, women are still less likely than men to receive critical treatments, such as percutaneous coronary intervention (PCI), during hospital admissions for MI, which exacerbates disparities.(2)
Females are less likely to undergo essential diagnostic procedures, such as coronary angiography, even when presenting with classic symptoms of MI. Most importantly, women are also significantly less likely to be prescribed guideline-directed secondary prevention medications at discharge, such as those sanctioned by European Society of Cardiology (ESC) guidelines or similar leading recommendations, a disparity contributing to poorer long-term outcomes despite equivalent or better survival rates in some contexts.(3) Such inequities highlight critical gaps in care despite Europe’s advanced healthcare infrastructure.
Increasing the inclusion of women clinical trials and prioritizing sex-specific cardiovascular research are crucial to bridging the gender gap in MI care. Research initiatives should focus on understanding how biological differences and social determinants impact the presentation, diagnosis, and outcomes of MI in females.(4) Additionally, studies must evaluate the long-term effects of underdiagnosis and undertreatment, as well as the barriers women face in accessing guideline-directed therapies.
Education initiatives tailored to healthcare providers must address biases and improve recognition of atypical symptoms in females, such as nausea, fatigue, or jaw pain, which are frequently mistaken for non-cardiac issues.(5) Programs should emphasize the importance of adherence to evidence-based guidelines for both diagnostic and therapeutic interventions. Furthermore, incorporating lessons learned from studies into medical education and training could help highlight specific areas where disparities occur and provide actionable strategies to mitigate them.
Collaborative efforts through public health campaigns and local, regional, national and international policies are also essential. Campaigns must aim to raise awareness about sex-specific risks and symptoms of MI among women, empowering patients to seek timely care. Policies should support funding for gender-specific programs, ensure equitable access to care across diverse socioeconomic settings, and promote accountability for implementing standardized practices. The integration of technology, such as artificial intelligence tools, could also enhance diagnostic precision and personalise care strategies, particularly for women with atypical presentations or complex comorbidities. Together, these measures can drive the harmonisation of care standards across member states and significantly reduce the gender gap in cardiovascular outcomes.
In conclusion, addressing gender disparities in MI care across Europe requires concerted action to ensure equitable, evidence-based, and gender-sensitive healthcare for all. This should remain a top priority for all caregivers and decision-makers.
Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.
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