NEWS
In Europe, women are less likely to develop cardiovascular disease — but more likely to die from it
Published Date – 17 June 2026
Cardiovascular disease remains the leading cause of death across European Society of Cardiology (ESC) member countries. Yet the latest 2025 ESC Atlas project report tells a story of progress. Over the past three decades, cardiovascular disease incidence and mortality rates have declined, reflecting advances in prevention, diagnosis, treatment, and healthcare delivery.
At the same time, the report highlights a reality that has become increasingly clear across cardiovascular medicine: improvements have not been experienced equally by everyone. When the data are viewed through a sex and gender lens, important differences emerge in risk factors, disease patterns, outcomes, access to care, and representation within the cardiovascular workforce.
Different risks, different realities
The report emphasizes the role of social and economic factors in shaping cardiovascular health, many of which continue to affect women differently than men.
Educational attainment is strongly linked to cardiovascular outcomes. Previous European analyses cited in the report found that lower educational status was associated with significantly higher risk of ischaemic heart disease (IHD) mortality, with the excess risk even greater among women than men. Across ESC member countries, women were slightly less likely than men to have completed upper-secondary education.
Employment patterns reveal similar disparities. Unemployment, a well-established risk factor for cardiovascular mortality, was higher among women than men across ESC countries and particularly pronounced in middle-income nations.
Lifestyle-related risk factors also demonstrate persistent sex differences. Physical activity is a well-established modifiable risk factor for cardiovascular disease – women were more likely to be insufficiently physically active than men. Obese individuals have a 50%–100% higher risk of death from all causes, with most of the increased risk due to cardiovascular disease, and obesity rates were higher among women in many middle-income countries.
Hypertension, the most significant modifiable risk factor for cardiovascular disease in the European region, has less favorable detection, treatment, and control rates for women than men.
Taken together, these findings remind us that cardiovascular risk is shaped by the social conditions in which people live, work, and age, not only by biology. Addressing cardiovascular disease, therefore, requires attention to both medical and societal determinants of health.”
When prevalence and mortality tell different stories
Across ESC member countries, men continue to experience higher incidence and prevalence rates for many major cardiovascular conditions. In 2023, overall cardiovascular disease incidence rates were nearly 30% higher in men than women. IHD incidence was almost twice as high among men, while stroke incidence was 28% higher.
Yet cardiovascular disease was responsible for a greater percentage of female deaths than male (39% v 34%).
Stroke illustrates this pattern particularly clearly. Although men experience higher incidence and prevalence, stroke accounted for a larger proportion of cardiovascular deaths among women. Similar patterns appear in other conditions. Atrial fibrillation is less common in women than men, yet mortality rates were higher among women. Heart failure prevalence was higher among men, yet women accounted for more than half of all heart failure deaths across ESC member countries.
These findings highlight that incidence and prevalence alone don’t tell the whole story. Understanding why women experience higher mortality in some conditions despite lower disease prevalence remains an important priority.
The challenge of recognition and treatment
The report also raises important questions about diagnosis and treatment.
Unlike most atherosclerotic diseases, peripheral artery disease (PAD) incidence and prevalence estimates were higher among women than men. The report suggests that these unusual patterns may partly reflect underdiagnosis and under-recognition, particularly among women.
The report also identifies persistent differences in access to procedures. Women represented just 28.6% of patients undergoing percutaneous coronary intervention (PCI) and only 22% of recipients of implantable cardioverter-defibrillators. Women accounted for approximately one-third of atrial fibrillation ablations and surgical aortic valve procedures.
These figures do not automatically indicate inequitable treatment, as procedure rates are influenced by disease prevalence, age, eligibility, and clinical presentation. However, they do highlight the need for continued investigation into whether women are receiving timely diagnosis, referral, and treatment across the cardiovascular care pathway.
The data gap remains a major barrier
For many procedures, sex-stratified information was available from only around half of ESC member countries. For some interventions, data availability was considerably lower, such as transcatheter mitral valve procedures (27% of countries), and for others not available at all.
This matters because without robust sex-specific data, it becomes difficult to identify disparities, evaluate outcomes, understand treatment effectiveness, or develop evidence-based strategies to improve care.
The inability to measure differences can inadvertently perpetuate them. Better data collection is a prerequisite for equitable cardiovascular care.
Why representation matters
Another critical dimension of equity is highlighted in the report: who is delivering cardiovascular care.
Women comprised approximately 40% of cardiologists across reporting ESC member countries, but representation varied dramatically. In high-income countries, women accounted for only around one-third of the cardiology workforce, but almost half in middle-income countries.
The picture becomes even more concerning in procedural specialties. Women represented just 11.5% of interventional cardiologists and only 8.8% of cardiac surgeons.
The report notes that the underrepresentation of women in the cardiovascular workforce may contribute to disparities in care through reduced diversity of perspectives and greater patient-physician discordance. This is where workforce equity and patient equity become closely connected.
A diverse cardiovascular workforce strengthens research, broadens leadership perspectives, improves innovation, and helps ensure that the needs of all patients are considered. Greater representation of women in cardiology is a healthcare quality issue.
A path forward
The report provides reasons for optimism. Cardiovascular mortality and incidence continue to decline across much of Europe. Progress is real, and millions of lives have benefited from advances in prevention and treatment.
Yet the report also demonstrates that sex and gender remain important determinants of cardiovascular health. Differences in risk factors, disease presentation, outcomes, treatment patterns, and workforce representation continue to shape the cardiovascular landscape.
Closing these gaps will require better data, more inclusive research, equitable access to care, and a cardiovascular workforce that reflects the patients it serves.
At Women As One, we believe these goals are interconnected. Advancing women in cardiovascular medicine is about more than creating opportunities for them. It’s about building a stronger, more inclusive cardiovascular community capable of delivering better science, better care, and better outcomes for all.
This report reminds us that progress is possible. The challenge now is to ensure that progress reaches everyone.
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