Translational Perspectives on Cardiac Diseases Disproportionately Affecting Women

Significant knowledge gaps persist on cardiovascular conditions that predominantly, disproportionately, or only affect women. Historically overshadowed by the focus on obstructive coronary artery disease, conditions such as myocardial infarction with nonobstructive coronary arteries, spontaneous coronary artery dissection, and Takotsubo cardiomyopathy have only recently gained research attention, despite substantial prevalence and impact among women. Similarly, coronary microvascular dysfunction and vasospastic angina, long dismissed as symptoms of psychological origin, are now recognized as common and underdiagnosed mechanisms of chest pain. Disparities in research also extend to heart failure with preserved ejection fraction, disproportionately affecting more women, and with comparable impacts on prognosis and quality of life, yet poorly understood compared with heart failure with reduced ejection fraction. Moreover, female hypertension is underestimated, underdiagnosed, and understudied. Furthermore, pregnancy-related cardiovascular complications, including preeclampsia and peripartum cardiomyopathy underscore the urgent need for research into sex-specific mechanisms and targeted preventive and therapeutic strategies, particularly in resource-limited settings. This review consolidates knowledge on cardiovascular conditions with pronounced sex differences, focusing on translational discoveries that direct current strategies, but most of all, emphasizing the need for future research to bridge the gap between mechanistic insights and clinical application. By identifying knowledge gaps, this article provides a road map for advancing sex-specific understanding and care in cardiovascular disease, ensuring progress in diagnosis, treatment, and prevention. Bridging the sex gap in cardiac research and care requires a multidisciplinary, globally inclusive approach. By integrating knowledge of biological, clinical, and sociocultural perspectives, we can move toward equitable and effective cardiovascular health for all.