Heart Disease Is Still the Number One Killer of Women: What Is Finally Changing for Women's Heart Health and Investors

Heart disease kills more women than all forms of cancer combined. Yet cardiovascular disease in women remains severely underfunded, underdiagnosed, and undertreated. According to new research from the McKinsey Health Institute and the American Heart Association, closing the cardiovascular disease gap between women and men in the United States could help women regain 1.6 million years of quality life and add $28 billion to the economy annually by 2040.

For investors focused on women's health, this represents a defining opportunity. Cardiovascular disease accounts for at least one-third of the women's health gap, yet fewer than 20 early-stage companies focus specifically on women's cardiac health. This disconnect between market size and investment attention mirrors the patterns that have made women's health one of the most compelling venture opportunities of the decade.

Why does heart disease remain the leading cause of death for women?

Cardiovascular disease is the leading cause of death for women in the United States, responsible for approximately 1 in every 5 female deaths. In 2023 alone, heart disease claimed the lives of nearly 305,000 women. More than 60 million women in the United States are currently living with some form of cardiovascular disease, and less than half recognize that heart disease is their number one killer.

The statistics are sobering: women are more likely than men to die from a heart attack, with 26% of women dying within a year of a heart attack compared to 19% of men. By five years after a heart attack, nearly half of women will have died, developed heart failure, or had a stroke, compared to 36% of men. Despite these stark differences, cardiovascular disease is still largely perceived as a male problem.

This perception gap has real consequences. For most of the twentieth century, medical research treated women's health as primarily reproductive health, leaving cardiovascular disease virtually unstudied in female populations. Women were believed to have natural protection from heart disease until menopause, and health screenings often focused narrowly on breast and reproductive health while overlooking cardiovascular risk factors.

The result is a healthcare system that continues to underdiagnose, undertreat, and underinvest in women's heart health. Heart disease affects women differently than men at biological, diagnostic, and treatment levels, but clinical practice has been slow to adapt to these realities.

How big is the burden of heart disease for women, employers, and health systems?

The burden of cardiovascular disease extends well beyond mortality statistics. Heart disease is the main cause of pregnancy-related deaths in the United States and a significant driver of long-term disability in women. Women who survive heart attacks often face extended recovery periods, higher rates of heart failure, and greater likelihood of secondary cardiovascular events.

The economic burden is substantial and growing. Cardiovascular disease currently costs the United States healthcare system more than $230 billion per year in direct medical costs and an additional $180 billion in lost productivity. By 2050, costs from cardiovascular diseases are projected to reach approximately $2 trillion. Women account for a significant share of this burden, with costs projected to increase more rapidly for women than for men over the coming decades.

For employers, the productivity impact is significant. Cardiovascular events lead to extended absences, short-term disability claims, and reduced work capacity among affected employees. Heart failure patients in particular face high rates of hospital readmission, with significant costs to both employers and health systems.

Beyond what shows up in claims data, women with cardiovascular disease often bear additional caregiving and family burdens. Many women delay seeking care due to family responsibilities, minimize their symptoms, or face challenges accessing cardiac rehabilitation programs that conflict with work and caregiving schedules. These hidden costs ripple through families and communities in ways that economic models only partially capture.

Why are women's heart attack symptoms and risks so often missed?

While chest pain remains the most common heart attack symptom for both men and women, women are much more likely to present with a broader array of additional symptoms. These can include shortness of breath, nausea or vomiting, back or jaw pain, unusual fatigue, dizziness, and discomfort between the shoulder blades. Women's chest discomfort may also fall short of the crushing pain typically associated with heart attacks in men, leading patients and providers alike to attribute symptoms to other causes.

Research has consistently shown that women often experience more varied symptom combinations than men, which can complicate diagnosis. Studies have found that women who sought medical care before hospitalization for a heart attack were significantly more likely than men to have their symptoms attributed to non-cardiac causes. This diagnostic delay can be life-threatening, as early intervention is critical for minimizing heart damage.

The problem extends beyond symptom recognition. Guidelines for diagnosing and treating heart disease were developed largely from studies conducted almost exclusively on men. Diagnostic criteria, treatment protocols, and clinical assumptions still reflect this male-centered foundation. Women who present with symptoms that do not match the classic male pattern are at heightened risk of having their concerns dismissed or their care delayed.

Women are also less likely to receive guideline-based therapies and interventions following a cardiovascular event. They receive fewer referrals for invasive procedures, are less likely to be counseled about cardiovascular risk reduction, and are under-referred to cardiac rehabilitation programs that could significantly improve their outcomes.

Where does the gender health gap show up in cardiovascular care?

The gender gap in cardiovascular care manifests across the entire continuum of research, prevention, diagnosis, and treatment.

1. Research gap:

Women remain significantly underrepresented in cardiovascular clinical trials. A comprehensive review of trials from 2010 to 2017 found that women comprised only 38% of participants. In trials focused on coronary artery disease and acute coronary syndromes, female representation dropped to approximately 27%. This underrepresentation means that treatment guidelines and therapeutic approaches have been developed without adequate understanding of how interventions work differently in women. Drug pharmacokinetics differ between men and women, yet extrapolating male-based study results to female patients remains common practice.

2. Prevention gap:

‍Women face unique cardiovascular risk factors that have only recently gained recognition in clinical practice. Pregnancy complications including preeclampsia, gestational diabetes, and preterm delivery are now understood to increase lifetime cardiovascular risk significantly. Women with a history of preeclampsia have more than double the risk of dying from a cardiovascular event in the decades following pregnancy. Gestational diabetes increases cardiovascular disease risk by 68% and raises the risk of developing type 2 diabetes tenfold. The menopause transition is associated with rising cardiovascular risk factors including adverse changes in cholesterol, blood pressure, and body composition. Women who experience early menopause face elevated heart disease risk. Despite these well-documented associations, systematic screening and follow-up for these pregnancy-related and menopause-related risk factors remains inconsistent.

3. Treatment and follow-up gap:

‍Women receive fewer procedures and interventions following cardiovascular events. Cardiac rehabilitation, a Class 1A recommendation for secondary prevention, is significantly underutilized among women. National data shows that women participate in cardiac rehabilitation at lower rates than men, with enrollment rates as low as 14% for women compared to 22% for men following a heart attack. Among women from underrepresented racial and ethnic groups, participation rates drop to 10 to 12%. Barriers to women's participation include lower referral rates, transportation challenges, caregiving responsibilities, scheduling conflicts, and program designs that do not accommodate the realities of women's lives.

Where is innovation emerging in women's cardiovascular health?

Despite decades of underinvestment, a new generation of companies and researchers is developing solutions that specifically address women's cardiovascular needs. Innovation is emerging across diagnostics, care delivery, and employer and payer engagement.

Which diagnostics and data tools are changing outcomes for women's cardiovascular disease?

New diagnostic approaches are being developed specifically for women's cardiovascular risk. Researchers are working on risk prediction tools that incorporate female-specific factors including pregnancy history, hormonal patterns, and menopause status. Companies are developing AI-powered diagnostics that can identify cardiovascular disease markers from existing screening modalities. One example is the use of artificial intelligence to detect coronary artery disease risk from routine mammograms, leveraging the 40 million annual mammograms performed in the United States to identify women at elevated cardiac risk.

Blood-based biomarkers and advanced imaging technologies are being refined to better detect the patterns of heart disease most common in women, including microvascular dysfunction and conditions such as spontaneous coronary artery dissection that disproportionately affect female patients. Data platforms that combine clinical records with real-world evidence are helping to identify high-risk women earlier and enable more personalized prevention strategies.

The American Heart Association recently launched a Heart and Brain Health Accelerator specifically focused on identifying and supporting technologies with potential to improve women's cardiovascular and brain health outcomes. Federal initiatives including the ARPA-H Sprint for Women's Health are also directing significant funding toward cardiovascular innovation for women.

How are care models evolving to fit the realities of women's lives?

Care delivery models are beginning to adapt to the ways that women experience cardiovascular disease. Integrated clinics are being developed that bring together cardiology, primary care, and obstetrics and gynecology to provide coordinated care across the life stages that affect women's heart health. Some centers are launching specialized women's heart health clinics that focus specifically on menopause-related cardiovascular risk, postpartum cardiovascular screening, and conditions that disproportionately affect women.

Virtual care and remote monitoring programs offer particular promise for women who face barriers to in-person cardiac rehabilitation and follow-up care. Telemedicine enables more frequent touchpoints without requiring women to navigate transportation, childcare, and work schedule conflicts. Remote blood pressure monitoring with clinical oversight can improve hypertension management, a critical component of cardiovascular prevention, particularly for postpartum women and those transitioning through menopause.

Emerging models are also connecting heart health with the broader context of women's health, recognizing that mental health, hormonal changes, and other conditions are intertwined with cardiovascular risk. Virtual group care programs that combine medical management with peer support and health coaching are showing early promise in engaging women who have not traditionally participated in cardiac prevention programs.

What role can employers and payers play in women's heart health?

Employers are increasingly recognizing that women's health, including cardiovascular health, is not a niche issue but a core driver of workforce productivity and retention. Women in midlife, when cardiovascular risk accelerates, are often at the peak of their careers and bear significant caregiving responsibilities. Cardiovascular events during these years can derail careers and impose substantial costs on employers through absenteeism, disability claims, and lost productivity.

Forward-thinking employers are moving beyond generic wellness programs toward benefits and screening programs that address women's specific cardiovascular risks. This includes coverage for cardiovascular screening tied to pregnancy history and menopause transition, access to cardiac rehabilitation programs that accommodate caregiving and work schedules, and mental health support that recognizes the connection between stress, depression, and cardiovascular risk.

Comprehensive workplace wellness programs focused on cardiovascular disease prevention have demonstrated positive returns on investment, with some studies showing returns of $2 to $6 for every dollar invested through reduced healthcare utilization and improved productivity. For employers seeking to retain and support female talent, investing in women's cardiovascular health represents both good business and good care.

How does women's heart disease fit Portfolia's women's health investing thesis?

Portfolia defines women's health broadly, encompassing conditions that affect women exclusively, conditions that affect women differently, and conditions that affect women disproportionately. Cardiovascular disease is a defining example of the second category: a condition that affects both men and women but manifests, presents, and responds to treatment differently in women.

This framing is critical. While cardiovascular disease is often overlooked in conversations about women's health investing, it represents one of the largest single contributors to the women's health gap. Cardiovascular conditions account for at least one-third of the gap between women's potential health outcomes and their current reality in the United States. Closing this gap represents a $28 billion annual economic opportunity.

Portfolia's women's health funds focus on innovations that can shift outcomes at scale. In cardiovascular disease, this means investing in diagnostic tools that account for female-specific risk factors and symptom patterns, care delivery models that fit the realities of women's lives, and data infrastructure that enables earlier identification and more personalized prevention for high-risk women. The fund evaluates companies across the cardiovascular ecosystem, from early detection and screening to treatment and long-term management, with a focus on solutions that specifically address the gaps in care that affect women.

As the most active investor globally in women's health, with more than 40 women's health companies in its portfolio across prior funds, Portfolia brings deep expertise in identifying and scaling innovations that serve women's unique needs. The fund's community-based model also means that investments are informed by nearly 2,000 members who understand firsthand the gaps in care that women experience.

Portfolia's commitment to advancing women's cardiovascular health extends beyond investment. CEO Trish Costello participates in a UCSF research study focused on women's heart health, wearing a heart monitor to collect and share data with researchers. This hands-on engagement reflects Portfolia's belief that closing the women's health gap requires not just capital, but active participation in the research and innovation ecosystem that will drive better outcomes for women.

How can investors partner with Portfolia to advance innovation in heart disease in women?

Portfolia offers a community-based model for investing in women's health that combines financial participation with education, engagement, and impact. The Women's Health Fund IV represents the next evolution of Portfolia's proven, category-defining investment strategy, backing high-growth, high-impact innovations transforming the health and wellness of women across every stage of life.

The fund invests across the spectrum of women's health, including conditions that affect women exclusively, such as endometriosis and menopause, conditions that affect women differently such as cardiovascular disease and Alzheimer's, and conditions that affect women disproportionately such as autoimmune disease and osteoporosis. Cardiovascular disease represents a core pillar of this thesis, given both the magnitude of the health gap and the relative lack of investment focus on solutions designed for women.

Portfolia evaluates founders working on cardiovascular disease in women within the context of its broader women's health portfolio, seeking innovations that demonstrate a clear understanding of how heart disease affects women differently and a compelling pathway to improving outcomes at scale. The fund's experienced investment team includes leaders with deep expertise in life sciences, healthcare, and women's health innovation.

For investors seeking to participate in the growing women's health market while supporting meaningful improvements in women's cardiovascular outcomes, Portfolia's Women's Health Fund IV offers a unique opportunity. To learn more about the fund and explore investment opportunities, contact the Portfolia team.

Disclaimer: This content is for informational purposes only and does not constitute investment advice, an offer to sell, or a solicitation of an offer to buy any securities. Investment in venture capital funds involves significant risk, including the potential loss of all capital invested. Past performance is not indicative of future results. Prospective investors should consult with their financial, legal, and tax advisors before making any investment decisions.

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