Why is the Leading Cause of Death in Women Still Overlooked?

Cardiovascular diseases are the leading cause of death in women, yet they remain underdiagnosed and invisible in both research and clinical practice.

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[This text is a collaboration between Women in Global Health (WGH) Spain and ISGlobal.]

Imagine a woman arriving at the emergency room with fatigue, nausea, and persistent pain in her jaw or back. It hasn't even crossed her mind that it could be a heart attack, because she has always heard that she would feel the classic pain in her chest or left arm. It is very likely that the medical staff won't suspect it at first either. However, she may be suffering from a heart attack.

On the occasion of Public Health Week 2026, we are shining a light on women's cardiovascular health. We cannot continue to ignore the fact that the leading cause of death in women remains under-researched, underdiagnosed, and underestimated.

Cardiovascular diseases are the leading cause of death for women worldwide (responsible for 8.6 million deaths per year), and yet they remain largely "invisible." Modern medicine was built on a male standard model and today, in the heart of 2026, women continue to pay the price of this heritage with their own lives.

The research gap: women absent from the evidence base

For decades, clinical research has been developed under an androcentric bias: men were studied and it was assumed that the results were applicable to the entire population. By not including enough women in clinical trials, much of the evidence used for the diagnosis and treatment of current diseases comes mainly from male populations. This has created a fundamental problem. We are applying medical evidence that does not adequately represent half of the population: women.

For decades, clinical research has been developed under an androcentric bias: men were studied and it was assumed that the results were applicable to the entire population

This historical exclusion has created what we know as the invisible burden of disease. It is not that women do not suffer from cardiovascular diseases; it is that science has not looked at their cardiovascular system through the same lens.

When symptoms deviate from the "classic"

The research gap translates into a dramatic reality in the doctor's office:

• Misleading symptoms: Women often present with cardiovascular symptoms that differ from the “classic” signs described in men. Instead of the characteristic chest pain, a heart attack in women can present as fatigue, nausea, jaw pain, shortness of breath, or back pain.
• Diagnostic errors: Due to these different symptoms, it is estimated that up to 50% of women are misdiagnosed or diagnosed at stages that are far too advanced.
• Misperception: A survey of 8,000 people revealed that only 34% identified cardiovascular disease as the leading cause of death in women. They wrongly believed that breast cancer was more lethal.

This lack of awareness, both in the general population and among healthcare professionals, means that symptoms can be overlooked, prevention strategies delayed, and resources allocated to other health areas considered higher priorities.

Three pillars for change

To close the gender gap and end gender inequality in research, we must transform the structure of global health—the evidence base.

1. Breaking with the standard model: We cannot apply the male model as the “only” or generalized one. We need to apply science using data that is disaggregated by sex in every clinical trial.
2. Funding with a gender perspective: Investment in women's cardiovascular health remains insufficient compared to the actual magnitude of the problem. We need resources specifically dedicated to understanding women's specific risk factors, clinical symptoms, how to diagnose them optimally, and their response to treatments.
3. Female leadership: Although women make up 70% of the healthcare workforce, we only hold 25% of leadership positions. This lack of female representation in senior research positions influences which research questions receive funding, which studies are prioritized, and how evidence is translated into public policy.

A call to action

Closing the gender gap in cardiovascular health is not just a matter of gender equity; it is an urgent public and global health necessity. To overlook the particularities of the female cardiovascular system is to ignore half of the world's population. Only by transforming the way we research, fund, and diagnose will we ensure that the leading cause of female mortality finally ceases to be an invisible burden.