November 2025
Closing the gender gap in heart disease outcomes: rapid change needed
By Rebecca Jenkins
Australian researchers say it is possible to reduce treatment differences between men and women with ST-elevation myocardial infarction (STEMI), but increasingly rapid change is needed to close the gap in the next decade.
Women with acute coronary syndrome were known to receive different treatment from men and to have poorer outcomes, researchers wrote in the MJA, but awareness of the issue had increased in the past two decades, sparking campaigns to improve recognition of heart disease in women and their outcomes.
To assess the situation in Australia, researchers conducted a retrospective study using data from 29,435 patients who presented to NSW hospitals with STEMI for the first time between 2011 and 2020. Patients had a mean age at admission of 66.1 years, and 28.8% of the cohort were women and 71.2% were men.
The data showed rates of timely invasive interventions increased more rapidly for women than men over the study period, and 12-month mortality declined more rapidly. However, considerable sex differences in the management and outcomes for people with STEMI remained.
Of female patients, 71.9% underwent angiography compared with 85.1% of men, and 54.4% of women underwent percutaneous coronary intervention compared with 70% of men.
The proportions of admissions followed by major adverse cardiovascular events or death of any cause were larger for female than male participants (18.4% vs 15% and 14.7% vs 8.5%, respectively).
‘Strategies are available for reducing differences in the management of women and men with STEMI, but they will not be completely overcome in the next ten years without more rapid changes,’ the researchers wrote.
In an accompanying editorial, Dr Esther Davis, Cardiologist and Researcher at the Victorian Heart Hospital, Melbourne, said the reasons for the sex differences were complex and included both sex-specific biological mechanisms in the pathophysiology of cardiac disease and gender-related health disparities.
She noted that female patients in the study were likely to be older at presentation and have higher levels of comorbidity than male patients, which was consistent with previous reports.
Speaking to Medicine Today, Dr Davis, who is also Co-Lead of the Women’s Heart Health Research Challenge at the Monash Victorian Heart Institute, Melbourne, said strategies which could reduce differences included clinician education on the ways cardiovascular disease presented in women and a push to include more women in cardiovascular research.
‘I think most importantly we need to increase public awareness to help women understand their risks of heart disease, what the symptoms of heart attack are and why it is important to present early to hospital,’ Dr Davis said.
‘Heart disease is common in Australian women, but many women do not understand this, so there is a role for GPs to help women understand their risk.’
She noted that many cardiac events were preventable if risk factors were treated appropriately.
‘Helping women know their numbers, blood pressure, cholesterol, and blood sugars, and controlling their risk factors can and will have a big impact in reducing cardiac events for women,’ Dr Davis said.