The increase in the prevalence of cardiovascular diseases (CVD) is one of Spain’s most pressing public health issues. Similar to other  Western countries, it is the leading cause of death for women and the second cause for men 

A recent report from the Spanish Society of Cardiology indicates that almost 69% of the population believes that mortality due to infarction is more frequent in men. However, in-hospital myocardial infarction mortality in women is 9% compared to 5% in men. For the public, cardiovascular diseases are generally perceived as a male health problem, resulting in women being understudied, underrecognized, underdiagnosed, and undertreated in women. 

Less Care and Attention: What About Women’s Health? 

The greater physical and mental burden due to their role as caregivers, or the poorer working and economic conditions that women often face, lead to more risk and less time for self-care 

Social conditions must be combined with historically unequal attention to symptoms. Women have different symptoms than men, which are less studied, and they are more intensely affected by certain heart conditions. As a result, women’s symptoms are more frequently unrecognized. 

Attention to women’s health in certain specialties such as gynecology, obstetrics, and primary care is very low in the policy and medical sphere, leading to fragmented care and the exclusion of many relevant conditions from women’s health pathways, such as cardiovascular diseases. 

Public Policies Against the Exclusion of Women’s Health 

In recent years, efforts have intensified to improve women’s health, as reflected in the Cardiovascular Health Strategy of the Spanish National Health System (ESCAV), a pioneering strategy in addressing cardiovascular diseases approved in 2022 by the Ministry of Health. 

Among the measures proposed by the strategy to tackle gender differences in the ESCAV, we find: 

GEN-ACC1.3: Develop cardiovascular health materials on health and gender and make them available to educational and health centers, equality organizations, and women’s associations. 

GEN-ACC1.4: Develop primary and secondary CVD prevention interventions specifically aimed at women, including addressing cardiovascular risk factors considering their differential characteristics in women. 

GEN-ACC1.5: Ensure a transversal gender approach in strategies, interventions, and health promotion and prevention materials related to CVD (e.g., smoking, physical exercise, nutrition, and care). 

GEN-ACC1.7: Ensure that all patient work strategies (health schools, patient schools, and others) take into account the characteristics of CVD in women, their specificity in terms of risk factors, education, and training for early symptom detection. 

The listed measures are appropriate, well-designed, and necessary, but are they being implemented? The Spanish Autonomous Communities, which are the entities responsible for implementing the Strategy, are still waiting to report any significant progress in this regard. 

While including the perspective of women’s health in the cardiovascular health strategy is a success in itself, administrations must be urged to go a step further and fulfill the path toward equity that the ESCAV marks. 

Structural Heart Disease: A Condition where gender bias and ageism converge 

Structural Heart Disease is a type of heart disease marked by ageism, with a prevalence of 12% in those over 75 years old. Consequently, their symptoms (shortness of breath, lack of balance, palpitations) are often naturalized and made invisible by considering them typical of ageing. The Spanish Strategy includes heart valve disease, a type of SHD, as one of its priorities due to its relation to the elderly population. 

Further to the geriatric angle of the disease, it is important to add the gender perspective. A study by the Spanish Society of Cardiology conducted for the Women’s Observatory indicates the existence of a different profile in terms of the etiology of valvulopathies according to gender, with rheumatic etiology predominating in women and ischemic or congenital etiology predominating in men. 

To avoid this problem and generate evidence, the Spanish Society of Cardiology recommends designing a registry that provides new information on the spectrum of valvulopathies in our environment. 

The Path to Equity 

Addressing gender differences in cardiovascular health is not only a matter of social justice but also of efficiency and effectiveness in healthcare. By recognizing and treating these disparities, the health and well-being of the entire population can be significantly improved. 

It is essential that administrations not only recognize these problems but also act to implement the proposed strategies, ensuring equitable and adequate care for women in all areas.