Heart disease has historically been studied, diagnosed and treated using a “male model” of the heart, as our Founder and CEO, Prof. Linda Worrall-Carter says, "women are not small men." We now know this approach misses important differences in how heart disease develops, presents and is managed in women.

Understanding sex differences is critical to improving outcomes for women.

Heart disease has historically been studied, diagnosed and treated using a “male model” of the heart. This approach assumes that women’s hearts behave like smaller versions of men’s — an assumption we now know is incorrect.

For decades, public awareness campaigns reinforced the image of the “Hollywood heart attack” — typically showing a man clutching his chest with pain radiating down the left arm. As a result, many women did not recognise their own risk, and symptoms in women were less likely to be identified early. Alongside this, research priorities and clinical teaching positioned heart disease primarily as a condition affecting men. It is not taught in medical curriculum or of it is, it is minimal.

Key differences include:

• Awareness and messaging
  Heart disease awareness campaigns have traditionally targeted men. This has contributed to lower awareness among women about their risk and the warning signs of heart disease.
• Under-representation of women in research
  Women have been included in cardiovascular research at significantly lower rates than men (26%). Some studies historically excluded women altogether, and many trials still enrol fewer women than expected based on disease burden. This will now change with the NHMRC who have announced that all research projects must consider sex, gender, variations of sex characteristics and sexual orientation at all stages.
• Limited sex-specific analysis
  Even when women are included in studies, results are not always analysed or reported separately by sex. This limits understanding of how heart disease presents and progresses in women.
• Impact on diagnosis and care
  When evidence is based largely on male data, women’s symptoms may be misinterpreted, diagnoses delayed, and access to tests or treatments reduced.

This is why recognising sex differences matters. It is not about comparison with men — it is about ensuring women’s biology, symptoms and experiences are reflected in research, clinical care and prevention strategies.

Women’s hearts and blood vessels differ from men’s in several important ways:

• Women generally have smaller coronary arteries
• Blood vessels may respond differently to injury or stress
• Disease of the small blood vessels (microvascular disease) is more common in women
• Plaque in women may erode rather than rupture, making it harder to detect on standard tests

These physical differences can influence how heart disease develops and how it appears on investigations such as angiograms.

Sex differences influence:

• How quickly women are diagnosed
• Which tests are ordered
• How symptoms are interpreted
• Access to procedures and treatments

Even when symptoms are similar, women are statistically less likely to receive some diagnostic tests (such as Stress tests, Angiograms) as well as less likely to receive interventions such as Angioplasty or stents.

Another important sex difference is who is included in research.

Historically:

• Women have been included in heart disease studies at much lower rates than men
• Many treatments and guidelines are based on male-dominant data
• Sex-specific analysis has often been missing

This limits how well research evidence reflects women’s real-world experiences.

Her Heart is working to address these gaps.

Through partnerships such as the National Cardiac Registry, sex-specific data is being analysed to better understand differences in:

• Access to care
• Treatment patterns
• Outcomes for women

In a report by the National Cardiac Registry on women and Percutaneous Coronary Intervention (PCI) – a life-saving procedure used to treat blocked arteries, key findings included:

• Women make up only 25% of PCI cases
• They present later and are, on average, 4 years older than men
• Higher rates of obesity and diabetes increase their risk
• Radial access – a safer approach – is used less in women
• Women wait 20 minutes longer for emergency PCI
• They face higher bleeding risks and in-hospital mortality

This work helps identify inequities, inform policy and improve heart care for women across Australia. For more information, please see the report here.

Sex differences help explain why women:

• Are often diagnosed later
• Experience different symptoms
• Can have different outcomes after heart events

Recognising these differences supports better conversations, better investigations and care that reflects women’s biology.

Heart disease in women is not the same as heart disease in men. Recognising sex differences is essential to improving prevention, diagnosis, treatment and outcomes for women.

At Her Heart, this is about equity, accuracy and better care for women.