Heart disease is the leading cause of death among women in the United States, yet it remains chronically underrecognized, underdiagnosed and undertreated in this population. According to research from the American Heart Association (AHA), by the year 2050, the rate of total cardiovascular disease (CVD) in women will rise to 14.4%, a 3.7% increase from 2020 data. Data for reproductive age women (ages 20 to 44) shows a similarly troubling increase, from 1 in 4 in 2020 to nearly 1 in 3 in 2050 having clinical CVD. Diabetes in this same young age group is also projected to more than double, from 6% to nearly 16%.
A critical opportunity exists at the intersection of prevention and rapid diagnostics in women’s health. Early intervention based on accurate diagnosis of both metabolic risk factors and acute cardiac events could help make the difference between life and death for women.
The diagnostic gap women face
Women in the U.S. are facing a cardiovascular crisis, and the diagnostic gap is persistently growing. According to a study, women are frequently underdiagnosed and undertreated despite having similar or greater cardiovascular risk compared to men, and are 50% more likely to have a heart attack misdiagnosed as gastrointestinal or anxiety-related symptoms. Research also found that women are 30% more likely to have their stroke symptoms misdiagnosed as another condition in the emergency department than men.
Women are also underrepresented and understudied in CVD clinical trials and are less likely to receive diagnostic imaging, percutaneous coronary intervention and statin therapy, even when presenting with comparable clinical indicators. Women with ST-elevation myocardial infarction also face higher rates of bleeding complications and 30-day mortality, underscoring the urgent need for more tailored diagnostic protocols, earlier metabolic risk detection and faster acute care in order to close the diagnostic gap.
Prevention: Catching risk before it becomes a crisis
Diabetes, hypertension and obesity are among the cardiovascular risk factors that disproportionately affect women the most and can be identified and managed before they progress to heart disease. The AHA projects that diabetes among women will increase from 15% in 2020 to over 25% by 2050, while obesity is expected to rise from 44% to 61% in the same time period. The 2025 American Diabetes Association (ADA) Standards of Care reinforce that prediabetes, defined by an HbA1c between 5.7% and 6.4%, is a significant risk factor for cardiovascular disease and develops silently, so many patients are unaware of the condition until it has already progressed.
Early testing can help change the trajectory of diabetes by shifting care from reactive to proactive. There has also been a significant change in how providers use fasting glucose, HbA1c and other biomarkers to personalize care plans and maintain insulin sensitivity. The ADA guidelines note that HbA1c offers low variability and a standardized measure of average glucose over time, making it a reliable tool for cardiometabolic monitoring. For clinicians, this means catching trends early and acting on them faster, and could mean guiding a patient toward lifestyle changes or starting treatment sooner, before diabetes fully develops and lasting damage begins.
There is also growing interest in C-peptide as an indicator of insulin production, adiponectin as a marker of insulin sensitivity, and other inflammatory markers such as CRP or interleukins. These markers are not replacements for standard diagnostic criteria, but they can provide a more comprehensive view of metabolic health, potentially helping to reveal subtle changes well before glucose levels become measurable.
When acute events occur, speed and precision save lives
Even with the best prevention strategies, acute cardiac events will occur. When they do, diagnostic speed and accuracy become critical. When a person experiences myocardial injury, the blood level of a protein called cardiac troponin increases. High-sensitivity (hs) troponin testing allows clinicians to detect very low levels of cardiac troponin with a high degree of precision. While contemporary troponin serial testing could take up to six hours, serial testing with hs troponin can be completed in one to two hours. This faster workflow can reduce length of stay in emergency departments, improving patient flow and helping prioritize care for those who need urgent intervention while safely ruling out cardiac events in those who do not.
A critical but overlooked variable: sex-specific thresholds
Research has found that hs cardiac troponin I (hs-cTnI) and T (hs-cTnT) have lower sex-specific 99th percentile upper reference limits in healthy females than males. However, these sex-specific thresholds may not be adopted into clinical practice, which can contribute to the underdiagnosis of acute myocardial infarction in women. In the High-STEACS trial, implementing an hs-cTn assay with sex-specific thresholds increased the diagnosis of myocardial injury in women by 42%, compared to just 6% in men, demonstrating that a uniform threshold systematically puts female patients at a disadvantage. High analytical precision at low and very low troponin levels helps ensure that small yet clinically meaningful changes are detected. Use of the sex-specific 99th percentile ensures women receive an appropriate diagnosis to get the care they need for a good clinical outcome.
Moving forward with a connected “prevent and treat” approach
Addressing the cardiovascular disease gap in women requires connecting the metabolic screening that happens in primary care with the rapid diagnostics that happen in the emergency department. Tools like the AHA’s Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) calculator can help estimate 10-year and 30-year risk for total CVD and guide primary prevention-focused treatment decisions. Also, earlier detection of prediabetes and other sources of metabolic risk creates the opportunity to intervene before a cardiac event occurs. When an event does occur, hs troponin testing continues to be foundational, supporting faster decision-making, improved patient flow and more 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’s responsible for providing medical support for the QuidelOrtho acute care menu throughout the product life cycle. Lindy 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, 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 an established record of publications in reputable peer-reviewed scientific journals. She’s also recognized as a leader at the intersection of science, technology and healthcare.
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