Heart disease in women is a silent threat with subtle symptoms like indigestion or back pain. Missed signs, bias, and late care put women at higher risk.
According to the Centers for Disease Control and Prevention, over 60 million women in the US, or about 44%, are living with some form of heart disease, and in 2023 it was responsible for the deaths of 304,970 women, about 1 in every 5 female deaths.
These signals can be brushed aside, leaving the real danger unseen. The problem grows worse with conditions like ischemia with no obstructive coronary arteries and spontaneous coronary artery dissection, both more common in women yet frequently missed. Add in healthcare bias, and diagnosis often comes too late.
But this does not have to be the case. With sex-specific tools, earlier detection methods, and treatments, lives can be protected and outcomes improved.
Heart disease is a silent threat for women because many do not show the “classic” chest pain, instead presenting with vague or less specific signs like indigestion or back pain. Conditions such as ischemia with no obstructive coronary arteries (INOCA) and spontaneous coronary artery dissection (SCAD), which disproportionately affect women, often go unrecognized. On top of that, gender bias in healthcare leads to delayed or missed diagnoses.
Heart disease is often called a “silent threat” in women because their symptoms are less obvious and frequently overlooked.
According to a review, about one-third of patients with acute coronary syndrome (ACS) in large cohort studies and one-quarter in smaller reports presented without chest pain. Importantly, 37% of women lacked chest pain compared to 27% of men, while in smaller reports, 30% of women reported no chest pain versus 17% of men.
This difference makes diagnosis harder, since chest pain has long been considered the hallmark sign of heart problems.
A study explained that women often experience symptoms labeled as “atypical,” such as:
They do not feel the classic crushing chest pain. Because of this, they are less likely to be diagnosed promptly, which delays treatment and worsens outcomes. The researchers emphasized that continuing to use “typical” and All these factors together explain why women remain at higher risk of being overlooked until the disease has advanced. Let’s understand more of that below. terms without clear reference groups disadvantages women and can reinforce these diagnostic gaps.
Another perspective comes from a narrative review, which highlighted that women are more likely to suffer from INOCA. This condition involves coronary microvascular dysfunction and can lead to angina, repeated hospitalizations, and lower quality of life. Since INOCA does not show the same artery blockages seen in men, it is often missed or underdiagnosed, adding to the silent nature of heart disease in women.
A review article also identified SCAD as an overlooked cause of heart attacks, particularly in younger women with few traditional risk factors. SCAD can strike suddenly, sometimes during pregnancy or after emotional or physical stress, making it both unexpected and difficult to detect. Its recurrence and links to systemic conditions such as fibromuscular dysplasia further complicate recognition.
Finally, a study noted that cardiovascular disease in women is underdiagnosed and undertreated because of a persistent belief that it mainly affects men.
Combined with the diagnostic challenges of subtle or non-classic symptoms, this perception contributes to misdiagnosis, poor management, and worse outcomes for women.
Earlier detection in women depends on better tools, such as coronary artery calcium (CAC) scoring to reveal silent plaque and sex-specific troponin thresholds to avoid underdiagnosis. Without them, many women remain falsely classified as low risk, delaying lifesaving interventions.
According to a study, earlier disease detection in women can be improved by using CAC scoring. In their Multi-Ethnic Study of Atherosclerosis (MESA), they analyzed 3,601 women aged 45 to 84 years.
Findings highlight that imaging can uncover hidden risks in women who might otherwise be overlooked by traditional scoring systems.
According to a 2024 study, high-sensitivity cardiac troponin assays also play a role in earlier detection. They studied 16,792 patients and found that using a uniform rule-out threshold identified more women than men as low risk for heart attack.
However, introducing sex-specific thresholds refined this process further, identifying different proportions of women and men as low risk. This adjustment made detection more accurate without sacrificing safety, since fewer than 0.1% of patients classified as low risk later suffered a heart attack or cardiac death.
According to 2024 systematic review, sex-specific troponin thresholds are essential because women consistently show lower 99th percentile values compared with men. Their review of 19 studies revealed that more than 90% of high-sensitivity cardiac troponin I assays and nearly 89% of troponin T assays reported lower female cutoffs.
This suggests that applying male thresholds to women could lead to underdiagnosis. Incorporating female-specific values could therefore improve diagnosis rates and outcomes in women presenting with chest pain.
According to another study, applying sex-specific thresholds in suspected acute coronary syndrome dramatically increased detection. In their study of 48,282 patients, the use of sex-specific cutoffs identified five times more additional women than men with myocardial injury. Detection in women rose by 42%, compared to only 6% in men.
Despite better identification, women were still treated less often with revascularization or preventive medications, showing that detection improvements must go hand in hand with equitable treatment.
Studies show that identifying early warning signs and applying effective therapies can make a major difference in outcomes.
Two key strategies, recognizing modifiable and sex-specific risk factors and using intensive statin therapy, stand out as vital steps in reducing cardiovascular disease among women.
According to a study, preventing and treating heart disease in women requires early identification and management of modifiable risk factors.
The authors highlighted that women face unique risks linked to sex-specific conditions such as:
These conditions raise cardiovascular risk significantly.
It also noted that women are disproportionately affected by diabetes, chronic kidney disease, and autoimmune inflammatory disorders, which further increase the chance of heart disease.
Because of this, they emphasized the need for earlier and more aggressive treatment strategies in women, especially those with these risk factors, to reduce the rising burden of atherosclerotic cardiovascular disease (ASCVD).
According to research, intensive statin therapy plays a key role in treating women after acute coronary syndromes.
In the PROVE IT-TIMI 22 trial, women who received atorvastatin 80 mg achieved a 42.8% reduction in LDL cholesterol within 30 days, lowering their median LDL to 60 mg/dL. In comparison, women on standard pravastatin therapy showed only a 16.8% reduction, with LDL levels at 88 mg/dL. Importantly, 88.8% of women on intensive therapy reached the LDL goal of under 100 mg/dL, and 65% achieved under 70 mg/dL.
Heart disease remains a silent threat for women because its signals often go unnoticed or are mistaken for less serious problems. Instead of the crushing chest pain many expect, women may feel indigestion, back discomfort, or burning in the chest.
Conditions such as INOCA and SCAD add to the risk, yet they are often overlooked. Gender bias in healthcare makes detection even harder, delaying diagnosis and treatment. The way forward is clear.
