The European Federation of Pharmaceutical Industries and Associations (EFPIA) and Vaccines Europe (VE) recently published a position paper supporting the development of a robust EU Cardiovascular Health Plan. Yet, across its 17 pages, the words “female” and “gender” appeared only once each. This highlights a broader issue: while cardiovascular disease (CVD) remains the leading cause of death in Europe—especially among women*—sex and gender differences are still too often overlooked in prevention, diagnosis, and care. The oversight extends beyond policy papers; across healthcare, male-focused research and clinical standards continue to shape outcomes.
In this Insight, Bax consultant Renato Odria explores how biology and systemic bias intersect in cardiovascular health, why inclusive research and care are urgently needed, and how empowering patients can help close the gap.
A leading cause of death – but still overlooked
Cardiovascular disease (CVD) remains the leading cause of death in the European Union (EU), accounting for approximately 42.5% of all deaths, equating to about 10,000 deaths each day. While hard to believe, remarkably, this is an improvement caused by advancements in science and innovation over the last 50 years. CVD mortality was at an all-time high after World War II, but has since declined thanks to advances in cardiac care, reperfusion therapy (treatment designed to restore blood flow), and secondary prevention. However, these advances have not benefited everyone equally. Historically, research has relied heavily on male animals and male clinical trial participants, resulting in treatments and diagnostic criteria that do not always account for female biology.
According to Eurostat data from 2022, CVD accounts for 35% of all female deaths and 30% of male deaths. Women are also twice as likely to die from CVD as from all forms of cancer. Despite this, clinical guidelines and diagnostic approaches are often based on male physiology and presentation, leaving many women underdiagnosed or misdiagnosed. Sadly, women continue to face higher rates of disability and poorer recovery from cardiovascular events. With life expectancy on the rise, the burden of CVD among older women is only expected to grow.
Biology matters: sex-based differences in risk and presentation
Biological sex plays a central role in how cardiovascular disease develops and presents. Men typically experience cardiovascular events earlier in life (often in their 40s or 50s), while women’s first events tend to occur 7–10 years later, usually after menopause.
Symptoms also differ significantly. Women are more likely to report fatigue, nausea, shortness of breath, or pain in the neck, jaw, or back. These “atypical” symptoms are frequently missed or downplayed in emergency settings, causing dangerous delays in treatment.
Risk factors vary by sex as well.
- Diabetes nearly triples CVD risk in women, compared to doubling in men.
- Smoking poses a 25–30% higher relative risk for women.
- Obesity and fat distribution affect risk differently across sexes.
- Pregnancy complications such as pre-eclampsia increase long-term cardiovascular risk.
- Autoimmune conditions, including lupus and rheumatoid arthritis, further heighten women’s cardiovascular risk.
Gender bias in care
Sex-based biology is only part of the story. Gender roles and systemic healthcare bias also significantly shape outcomes. Women often prioritise family health over their own, delaying care. In fact, it has been found that up to 41% of women wait more than 12 hours to seek medical care after experiencing chest pain. Meanwhile, healthcare systems, often fail to recognise gender-specific needs. Women are less likely to be referred for advanced diagnostics or receive evidence-based interventions, and are more likely to have their symptoms dismissed as stress or anxiety.
This is further amplified by the fact that although women tend to be the majority of medical graduates, men still dominate senior cardiology and general leadership positions, perpetuating gender imbalance in research and clinical decision-making.
Empoweing patients for change
Bridging the cardiovascular gender gap requires more than clinical knowledge; it calls for patient empowerment. Educating and equipping patients with information, tools, and confidence helps them recognise symptoms early, manage key risk factors, and engage in shared decision-making. Empowered patients are more likely to manage key cardiovascular risks like blood pressure, blood sugar, and cholesterol — yielding better outcomes and long-term cost savings for European health systems.
Encouragingly, initiatives are emerging. The European Society of Cardiology (ESC) has established a Gender Task Force to address systemic and institutional barriers affecting women in cardiovascular research and care. The ESC and organisations such as the World Heart Federation provide accessible, patient-focused resources to raise awareness and promote prevention.
At the policy level, the European Commission has placed sex and gender equity at the core of its Horizon Europe research framework, recognising that equitable research design is essential to improving cardiovascular outcomes. Continued funding for such initiatives will be crucial to sustaining progress.
The way forward: inclusive care, research and education
Improving cardiovascular health across Europe requires integrating both biological and social perspectives into policy, research, and practice. This means:
- Embedding sex and gender analysis in research design and reporting.
- Ensuring diverse participation in clinical trials.
- Developing diagnostic and treatment protocols that reflect real-world populations.
- Educating clinicians to recognise sex- and gender-specific risk factors and symptoms.
By centring patients in their care and designing systems that value equity, we can reduce the burden of CVD for all. This calls for sustained investment—in healthcare systems, in inclusive education for practitioners, and in research that fully accounts for sex and gender.
*Note on terminology: Throughout this article, we refer to “men” and “women” in the context of sex-based biological differences that influence cardiovascular health, as this reflects the way most current research and clinical data are framed. However, we recognise that gender exists on a spectrum, and that cardiovascular disease also affects transgender, non-binary, and gender-diverse people – whose experiences are often underrepresented in both care and research. Inclusive approaches are essential to ensure equitable cardiovascular outcomes for all individuals.
Work with us to drive better healthcare
In the Healthcare Innovation team, we believe that healthcare systems are among society’s most valuable assets, and we work to secure their sustainability for future generations. We do so by focusing on three main workstreams:
Tackling bottlenecks: Recognising the limitations of current frameworks, we bring stakeholders together to accelerate the adoption of innovative treatments and technologies, ensuring equitable access to quality care.
Facilitating the adoption of innovative solutions: Leveraging our sector’s expertise and extensive networks, we offer strategic insights into healthcare markets, competing technologies, and emerging trends.
Empowering patients & citizens: Through our experience in Patient and Public Involvement (PPI) and healthcare innovation, we empower patients and citizens to actively participate in the management of their health.
Want to collaborate or learn more? Get in touch.
