BANGKOK -- By Kim Ji-hye/Korea Biomedical Review correspondent -- Heart disease doesn’t follow the same script for everyone.

While classic symptoms like chest pain may show up in both men and women, in Korea, the stakes are higher for women. Women face a higher prevalence of heart failure, and their age-standardized mortality rate surpasses that of men. Despite Korea's overall reduction in cardiovascular deaths in the last decade, heart failure has surged, particularly among the elderly. But why are women hit harder?

At the Asia-Pacific (APAC) Heart Summit held over the weekend in Bangkok, Thailand, Arun Jose, head of the BRIDGE Centre for Digital Health at the Centre for Chronic Disease Control in India, tackled this very question. During a panel discussion on equity in cardiovascular disease (CVD) care on Saturday, he pointed out that it’s not just about lifestyle; biology plays a powerful role.

"The anatomy sets the stage," he said, explaining that women’s smaller arteries complicate procedures like revascularization. 

Anatomical differences, such as those in the aortic arch, mean women experience more complications after vascular surgeries. Even their heart failure looks different—women often present with preserved ejection fraction, which comes with worse outcomes compared to the reduced ejection fraction seen in men.

Jose didn’t mince words: "There’s a significant lack of awareness and sensitivity within the  healthcare community regarding these gender-specific differences, and that gap is costing lives.” He emphasized that it’s not just about the anatomy of the heart; it’s also about the healthcare system's failure to recognize and address these disparities.

In Korea, the national health screening program includes tests for hypertension and dyslipidemia among others, but according to Azwar Kamarudin, director of public affairs in the APAC region at Novartis, the system is “male-centric.” Lipid tests, crucial for detecting early warning signs of CVD, start for women at 40, while men are tested from 24 in Korea. 

"Women need to be more proactive in seeking care," Kamarudin said, recalling how the only time she was encouraged to get screened was when her husband went in for a flu shot. She pointed out that many women don't get checked until their symptoms scream for attention, often when it’s already too late.

Anne-Frieda Taurel, consultant epidemiologist of IQVIA APAC in Singapore agreed, noting that women often miss out on preventative care, which is key to avoiding the worst outcomes. "We pour money into oncology and fertility, but CVD in women remains overlooked" she said, calling for more funding and clinical trials that include—and focus on—women.

According to the APAC CVD Alliance, Korea is advocating for earlier and more frequent screenings, starting at age 20 for women, but Taurel said the variations in both symptoms and outcomes demand further research, as the missing link in women's healthcare might just be what we can't see.

Across the globe, women are severely underrepresented in clinical drug trials, leaving vast gaps in treatment guidelines. Only 30 percent of CVD trials include women, largely due to the pharmaceutical industry’s hyperfocus on childbearing potential. 

When women seek screenings, reproductive health often takes precedence, while heart health tends to be overlooked, overshadowed by a primary focus on breast cancer. This oversight carries serious consequences—heart disease doesn’t announce itself with clear symptoms, leaving many women to suffer in silence until it's too late. Moreover, women respond differently to treatments, influenced by metabolic and hormonal factors that remain largely unexplored.

"The risks of excluding women from trials are real," warned Taurel. "If safety profiles are based on males, women are more likely to react negatively." 

But this disparity extends beyond drug trials; gender significantly impacts how diseases affect us, particularly infectious diseases. Women, for instance, have a stronger immune response to infections like influenza, which can manifest as fever and fatigue. These symptoms, however, are often dismissed by healthcare providers as minor, leading to dangerous delays in diagnosis. 

Kamarudin knows this tragedy all too well. "I’ve seen relatives—especially aunts—pass away from cardiac arrest, without anyone realizing they were struggling with it for years," she said.

In contrast, men’s more severe respiratory symptoms tend to prompt earlier intervention. Taurel points out that this reflects a similar dynamic in cardiovascular care, where women’s "atypical" symptoms frequently go overlooked until it’s too late.

"When women finally seek care, they’re already in deep trouble," said Taurel, noting that many women delay treatment due to caregiving duties. Social determinants trap them in a cycle of neglect—referrals are delayed, treatment postponed, and outcomes worsen.

For Jose, addressing this gap in the healthcare system requires transformation beginning at the community level. "We must promote women’s involvement in their own healthcare decisions," he said. 

He emphasized that researchers and clinicians need to act now. "We can’t develop effective interventions if half the population is left out of the research," he said. “The stakes are too high for healthcare systems to continue delivering one-size-fits-all care. Gender-sensitive care needs to be integrated at every level, from screenings to policy reform.”

"It’s astonishing how many people still lack access to essential screening tests," said Beatrice Vetter, director of non-communicable diseases at Switzerland-based FIND Diagnostics. Vetter spearheaded a project in India that mobilized women’s health support groups to integrate blood pressure and diabetes screenings into their home visits. These initiatives brought healthcare directly into the community, allowing individuals to receive tests without ever leaving their neighborhoods.

“What was particularly powerful was the way it empowered women,” Vetter said. By offering screenings in familiar, comfortable settings, she said the initiative reduced the stigma associated with health testing. “People often fear getting tested because they worry something might be wrong. But when it’s done by women from their own community, that fear fades. It builds trust."

In regions across APAC—rural Indonesia, Malaysia, Thailand—social barriers are especially stark. Most doctors are men, and for women in conservative areas, it’s not easy to discuss personal health issues like chest pain or cholesterol with male doctors.

“They often shy away from those conversations, but it’s different when they talk to female doctors,” said Kamarudin. “Women feel more comfortable sharing information with each other and are likely to follow up with questions like, ‘What should I do with my medication?’ They may hesitate to ask their husbands or return to a male doctor, so having female doctors in these settings is crucial.”