Why heart disease is so often undiagnosed in women

The University of Kentucky Public Relations & Strategic Communications Office provides a weekly health column available for use and reprint by news media. This week’s column is by Nouran Sorour, M.D., associate professor of internal medicine in the UK College of Medicine and cardiologist at UK HealthCare’s Gill Heart & Vascular Institute.

LEXINGTON, Ky. (Dec. 15, 2025) — As a cardiologist, I see this far too often: women come to us later in the course of heart disease, sometimes after weeks or even months of vague symptoms that were dismissed or misdiagnosed. We’ve made significant advances in cardiology, but one thing hasn’t changed enough: Heart disease in women still flies under the radar. That’s something I’m passionate about changing.

Heart disease in women

Heart disease in women is often underdiagnosed compared to men.

One reason is historical. For decades, most of our understanding of heart disease came from studies done on men. This means that many of the “typical” warning signs for heart attacks in men, like crushing chest pain, may not apply to women.

In my experience, many women don’t have the “Hollywood heart attack” we think of, which involves dramatic chest pain or collapse. Instead, they may feel:

• Unusual fatigue
• Shortness of breath
• Nausea or dizziness
• Discomfort in the neck, jaw or back
• Anxiety or a sense that “something’s off”

These symptoms are easy to overlook, by both patients and physicians, and that’s exactly what makes heart disease so often unrecognized in women. 

With better technology and research, we now know that women's hearts can behave differently than men’s, especially when it comes to symptoms and disease patterns. Unfortunately, in some instances, those differences aren’t always recognized in time.

Symptom awareness

Being aware of the symptoms of heart disease plays a huge role in diagnosis and treatment.

I often ask patients if they’re worried about their heart, and many women say “no” because they didn’t think they were at risk. This leads to untimely recognition and diagnosis of heart conditions.

Some barriers to timely and effective care include:

• Symptoms that don’t “fit the mold”
• Prioritizing others’ needs over their own (especially caregivers and mothers)
• Dismissive encounters with health care providers
• Socioeconomic challenges like cost, transportation or childcare
• Low representation in clinical trials, which affects how we diagnose and treat heart disease in women

Studies show that only half of women realize heart disease is their No. 1 health threat. This lack of awareness leads to delays in seeking care and fewer preventive conversations during routine visits.

We need to change the system — but we also need to empower women to speak up.

Advocating for yourself

I tell my patients this: You know your body. Trust yourself.

If something feels wrong, don’t minimize it. Be clear about your symptoms, and don’t be afraid to ask:

• “Could this be my heart?”
• “Can we check my risk factors?”
• “Can I see a cardiologist?”

Preventive steps that can reduce heart disease risk

The best defense is prevention, and small changes go a long way. At UK HealthCare, we focus a lot on prevention and education, because we know most heart disease is preventable with early action. I encourage women to:

• Quit smoking
• Stay physically active (even brisk walking counts!)
• Eat a heart-healthy diet (like the Mediterranean diet)
• Control blood pressure, cholesterol and blood sugar
• Maintain a healthy weight
• Learn their family history
• Manage stress and get regular sleep

Improved detection in women

Through advanced technologies, we’re now using high-sensitivity blood tests (like troponins) that help detect heart damage earlier in women. We are also getting better at diagnosing non-obstructive coronary disease and microvascular dysfunction, which are more common in women.

We have also been able to expand our use of advanced imaging, such as cardiac MRI and stress echo, especially when standard tests don’t tell the full story. Lastly, we’re also pushing for more inclusive research that looks specifically at how heart disease affects women.

At UK HealthCare, this issue is front and center for us. We’re pushing to make women’s cardiovascular health a priority in medical education, working across specialties — like OB-GYN, primary care and cardiology — to improve detection and follow-up, and engaging in community outreach and screening events to raise awareness

Overall, we want women to feel heard, protected and cared for, whether they’re coming in with chest pain or just checking in on their heart health.

If you’re a woman reading this or if you love one, please know this: Heart disease is not just a man’s problem. And it’s not always obvious.

Listen to your body. Speak up. Ask questions. And don’t wait. We’re here to listen — and to act — because your heart matters just as much as anyone else’s.