Cardiovascular disease remains the leading cause of death for women worldwide, yet disparities in diagnosis, treatment, and research are still widely overlooked. The latest findings from the Canadian Women’s Heart Health Alliance (CWHHA) ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women, particularly Chapter 9, highlight the persistent challenges women face in receiving equitable heart care. This chapter serves as a call to action for healthcare providers, researchers, and policymakers to bridge the existing gaps and improve outcomes for women with cardiovascular disease.
Persistent Disparities in Diagnosis and Treatment
Despite advancements in cardiovascular medicine, women continue to experience delays in diagnosis due to a lack of awareness regarding sex-specific symptoms. Unlike men, who typically present with classic chest pain, women with heart disease often experience nausea, fatigue, and jaw pain, leading to misdiagnoses or delays in care. Standard laboratory tests and diagnostic criteria frequently fail to account for sex-specific thresholds, further contributing to underdiagnosis. Even when correctly diagnosed, women are less likely to receive evidence-based treatments such as statins, aspirin, or interventional procedures like angioplasty. This disparity significantly impacts long-term health outcomes and contributes to higher mortality rates among women with cardiovascular disease.
Research and Clinical Trials Have Historically Excluded Women
The underrepresentation of women in cardiovascular research is a longstanding issue, with studies showing that women are enrolled in clinical trials at a ratio of approximately 4:1 compared to men. This lack of inclusion results in treatment guidelines that are often based on data from male-dominant populations, despite growing evidence that cardiovascular disease manifests differently in women. Furthermore, many clinical trials do not analyze or report results based on sex differences, limiting the ability to develop tailored treatments for women. The ATLAS study emphasizes the need for greater inclusion of women in research to generate sex-specific data that can improve clinical decision-making and treatment efficacy.
Women Face Unique Risk Factors
In addition to traditional cardiovascular risk factors like hypertension, smoking, and diabetes, women face unique biological and hormonal risks that are often overlooked. Conditions such as hypertensive disorders of pregnancy (including preeclampsia and gestational hypertension), polycystic ovarian syndrome (PCOS), premature menopause, and autoimmune diseases like lupus and rheumatoid arthritis significantly increase a woman’s risk for developing heart disease. However, these factors are rarely included in standard cardiovascular risk assessments, leading to missed opportunities for early intervention. Recognizing and addressing these sex-specific risk factors is essential for improving cardiovascular outcomes for women.
Social Determinants of Health and Access to Care
Beyond biological differences, social determinants of health play a critical role in women’s cardiovascular health. Women—particularly those from racialized and Indigenous communities—face significant barriers in accessing timely and adequate care. Geographic location, income level, and systemic biases contribute to disparities in diagnosis, treatment, and follow-up care. Women from underserved populations are often diagnosed at later stages of heart disease, receive fewer referrals to specialists, and experience higher mortality rates from cardiovascular disease-related complications. Addressing these systemic inequities is crucial to ensuring that all women receive the care they need.
Moving Forward: Recommendations for Improving Women’s Cardiovascular Health
The CWHHA ATLAS outlines several key recommendations to bridge the gender gap in cardiovascular care. Increasing awareness and education for both healthcare professionals and the public is a priority, as early recognition of sex-specific symptoms can lead to faster and more accurate diagnoses. Implementing sex-specific diagnostic criteria and ensuring equitable access to evidence-based treatments can improve clinical outcomes. Additionally, mandating the inclusion of women in cardiovascular research and ensuring that clinical trials analyze sex-based differences will help refine treatment guidelines. Expanding access to specialized cardiac rehabilitation programs for women is also essential, as participation in such programs significantly improves recovery and long-term health.
How SonoSim Can Help Address These Challenges
One of the key barriers to improving cardiovascular outcomes for women is the need for better diagnostic skills among healthcare providers, particularly in recognizing and managing sex-specific presentations of heart disease. This is where SonoSim can play a pivotal role. With SonoSim’s ultrasound training ecosystem, clinicians and medical students can develop proficiency in cardiac ultrasound imaging, an essential tool for early and accurate diagnosis of conditions like heart failure, valvular disease, and acute coronary syndromes. Point-of-care ultrasound (POCUS) applications can help detect subtle cardiovascular abnormalities that might otherwise be missed, and ultrasound-guided procedures ensure that women receive optimal interventional care when needed.
What sets SonoSim apart is its extensive library of real patient cases, featuring scans from both women and men of all body morphologies. This diversity ensures that healthcare providers train on a wide spectrum of normal and pathologic conditions across different patient populations. By practicing on real patient imagery rather than computer-generated graphics, learners develop the ability to recognize subtle variations in cardiovascular presentations, improving diagnostic accuracy and decision-making. With unlimited, on-demand access to these real-world cases, SonoSim equips healthcare providers with the skills necessary to recognize and address the unique cardiovascular challenges that women face.
Conclusion
The findings from the CWHHA ATLAS reinforce an urgent need for systemic changes in how cardiovascular disease is diagnosed, treated, and researched in women. From improved education and awareness to policy changes and research initiatives, a multi-faceted approach is required to close the gender gap in cardiovascular care. By leveraging innovative educational tools like SonoSim, healthcare providers can enhance their diagnostic capabilities and contribute to better, more equitable cardiovascular outcomes for women. The time to act is now—because every heartbeat counts.