Closing the Women’s Heart Health Gap: Prevention, Early Detection, and Precision Diagnostics

Heart disease remains the leading cause of death among women in the United States, yet it is persistently underrecognized, underdiagnosed, and undertreated. American Heart Association data project total cardiovascular disease in women will reach 14.4% by 2050, up from 2020 levels, with reproductive-age women facing parallel increases in both CVD and diabetes prevalence.

The intersection of prevention and rapid diagnostics represents a critical opportunity in women’s health. Early intervention based on accurate identification of metabolic risk factors and acute cardiac events can be decisive.

Women face a persistent diagnostic gap. Research indicates they are underdiagnosed and undertreated despite comparable or higher cardiovascular risk than men, with heart attacks 50% more likely to be misdiagnosed as gastrointestinal or anxiety-related issues, and stroke symptoms 30% more likely to be missed in the emergency department. Women are also underrepresented in CVD trials, less likely to receive imaging, percutaneous coronary intervention, or statin therapy, and experience higher rates of bleeding complications and 30-day mortality after STEMI, underscoring the need for tailored protocols.

Prevention starts with catching risk before it escalates. Diabetes, hypertension, and obesity disproportionately affect women, with AHA projections showing diabetes rising from 15% to over 25% and obesity from 44% to 61% by 2050. ADA Standards highlight prediabetes—defined by HbA1c between 5.7% and 6.4%—as a silent but significant cardiovascular risk factor.

Early testing shifts care from reactive to proactive. HbA1c offers a standardized, low-variability measure of average glucose over time, enabling clinicians to identify trends early and intervene with lifestyle changes or treatment before diabetes fully develops.

Emerging biomarkers such as C-peptide, adiponectin, CRP, and interleukins provide additional insight into insulin production, sensitivity, and inflammation. While not replacements for standard criteria, they can reveal subtle metabolic changes well before glucose levels become measurable.

When acute events occur, speed is essential. Cardiac troponin rises after myocardial injury, and high-sensitivity troponin testing detects very low levels with precision. Serial hs troponin testing can be completed in one to two hours versus up to six hours with contemporary assays, reducing emergency department length of stay and helping prioritize urgent care.

Sex-specific thresholds are a critical but often overlooked variable. hs-cTnI and hs-cTnT have lower 99th percentile upper reference limits in healthy women, yet uniform thresholds are still commonly used. The High-STEACS trial showed that adopting sex-specific thresholds increased myocardial injury diagnosis in women by 42% compared to 6% in men, demonstrating that uniform criteria systematically disadvantage female patients.

Addressing the cardiovascular disease gap requires connecting metabolic screening in primary care with rapid diagnostics in the emergency department. Tools like the AHA PREVENT calculator estimate 10-year and 30-year CVD risk to guide prevention, while earlier detection of prediabetes enables intervention before cardiac events occur. When events do happen, hs troponin testing supports faster decision-making and personalized risk assessment.

Photo: hudiemm, Getty Images

Dr. Lindy Carlstrom’s clinical experience spans from emergency medicine to critical care and primary care. Currently Global Medical Affairs Manager, she provides medical support for the QuidelOrtho acute care menu throughout the product life cycle and is passionate about clinical education, testing guideline updates, and assay utilization to drive improved patient-centered outcomes.

Dr. Qian Ding, MD, PhD, Senior Medical Affairs Manager at QuidelOrtho, brings extensive experience in hospital laboratory and in vitro diagnostics with a strong command of healthcare information systems and data analytics. With a comprehensive background in microbiology, immunology, molecular genetics, and healthcare business intelligence, Dr. Ding is also an accomplished researcher with publications in reputable peer-reviewed scientific journals and is recognized as a leader at the intersection of science, technology, and healthcare.

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