The female heart is receiving more of the attention it deserves
In a nutshell:
- Cardiovascular disease is the leading cause of death among women worldwide.
- A heart attack can present differently in women. Chest pain or pressure remains the most common symptom, but additional symptoms are sometimes less easily recognized.
- Female-specific risk factors require more targeted diagnosis and care.
- Since 2023, awareness has increasingly been translated into action, with new European initiatives, a care model for women's heart centres, an updated definition of myocardial infarction, and a Belgian Gender Task Force.
Emeline Van Craenenbroeck is a professor of cardiology at UAntwerp and a heart failure specialist at Antwerp University Hospital (UZA). In 2023, she explained in one of our articles why heart attacks in women had remained underrecognized for too long. That analysis still holds true today. However, a more concrete response is now emerging through research, diagnostics, healthcare and policy. In light of the Heart Week campaign organized by the Cardiological League, we are once again shining a spotlight on women's heart health.
One classic image, but not the whole story
A man leaving a restaurant on a cold day, clutching his chest as he is overcome by severe pain. This familiar image, immortalized in the medical illustrations of Frank Netter and known to generations of medical students, shaped our understanding of what a heart attack looks like. The image is not wrong, but it is incomplete.
"The classic image of a heart attack is certainly accurate, but only for a specific group of patients: men. In women, it can look quite different," says Van Craenenbroeck. Pain, pressure or a tight feeling in the chest remains the most common symptom in both men and women. The pain may radiate to the arm, back, jaw or teeth. However, women relatively often report additional symptoms that are less readily associated with heart disease, such as nausea, dizziness, unusual fatigue or shortness of breath. That is precisely where the danger lies. When people fail to recognize these signals, they may consider them less urgent and delay seeking medical attention.
Risk factors that too often go unnoticed
The well-known risk factors remain important for everyone: smoking, high blood pressure, diabetes, obesity, high cholesterol levels and lack of physical activity. These factors can cause the large coronary arteries to become narrowed or blocked, leading to the classic type of heart attack. Although this remains an important cause of heart attacks in both men and women, other disease processes occur relatively more often in women and are less easily detected through standard examinations.
Pregnancy complications such as pre-eclampsia (pregnancy-related high blood pressure) can be an early warning sign of increased cardiovascular risk later in life. Hormonal changes and early menopause may also play a role. For that reason, it is not enough to look only at the traditional risk factors. A woman's pregnancy history and different life stages should also be considered as part of a cardiovascular risk assessment. Moreover, the problem is not always caused by a clear narrowing of the major coronary arteries. In women, symptoms are relatively often linked to dysfunction or spasms of the small blood vessels that supply the heart.
Not every heart condition requires the same approach
This has important implications for diagnosis and treatment. A stent can keep a narrowed coronary artery open, but it does not solve every problem. "If no narrowing of the large blood vessels is found during a procedure, the investigation should not automatically stop," Van Craenenbroeck emphasizes. Additional imaging or functional testing of the small blood vessels may be necessary to determine what is actually causing the symptoms.
The same applies to medication and cardiac rehabilitation. Women have long been underrepresented in cardiovascular research, and this remains the case today. "We must do everything possible to remove barriers and actively recruit female participants. At present, we still do not know enough about the extent to which results obtained in men also apply to women, for example when it comes to the most appropriate medication or dosage."
“The classic image of a heart attack is certainly accurate, but it reflects only one group of patients: men. In women, a heart attack can present very differently.”
From awareness to concrete change
Improving the detection and follow-up of heart disease in women is a matter of life and death. "Cardiovascular disease is the leading cause of death among women worldwide, even surpassing breast cancer," says Van Craenenbroeck. In 2023, her message focused largely on raising awareness. Three years later, the problem has not disappeared, but tangible progress is becoming visible.
More attention at the European level
With the European Safe Hearts Plan of December 2025 and a growing policy focus on women's health across Europe, women's cardiovascular health is gaining a more prominent place on the agenda. The Safe Hearts Plan explicitly addresses gender inequalities and aims to strengthen cardiovascular research, innovation and prevention efforts across Europe.
A new definition aimed at preventing missed heart attacks.
In August 2026, a new international definition of myocardial infarction was published by the ESC, ACC, AHA and World Heart Federation. For the first time, it includes sex-specific troponin thresholds. Troponin is a blood marker used to detect heart muscle damage. These new thresholds should help improve diagnostic accuracy in women. The updated definition also gives greater recognition to SCAD, a spontaneous tear in the wall of a coronary artery that predominantly affects women, and MINOCA, a heart attack that occurs without a clear blockage of the coronary arteries.
Belgium is also taking action
In 2026, the Belgian Society of Cardiology established a Gender Task Force. Its goal is to better integrate sex and gender differences into cardiovascular research, education and patient care. Van Craenenbroeck is a member of this task force. Meanwhile, the Women and Heart Clinic at UZA is conducting research into early signs of vascular damage and cardiovascular risk in women who have experienced pregnancy complications such as pre-eclampsia.
The female heart deserves its own approach
The main conclusion from 2023 still stands: cardiovascular disease in women should not be viewed merely as a variation of what is seen in men. Differences in symptoms, risk factors and disease mechanisms must be taken into account from the very start of research and clinical care. Yet today's message is ultimately more hopeful. Women's heart health is no longer dependent solely on awareness campaigns. New research programmes, specialized care models, updated diagnostic criteria and structural collaborations are beginning to take shape. The challenge now is to translate these initiatives into everyday clinical practice, ensuring that every woman receives the right diagnosis, treatment and follow-up care as quickly as possible.