New heart attack definition promises better care for women

The world’s four leading cardiovascular health organisations – the European Society of Cardiology, the American College of Cardiology, the American Heart Association and the World Heart Federation – have jointly issued the first universal definition of a heart attack that recognises sex‑specific diagnostic thresholds. Announced at the ESC’s annual congress in Munich, the new guidance upgrades three forms of myocardial infarction that are up to ten times more common in women – coronary artery spasm, coronary embolism and spontaneous coronary artery dissection (SCAD) – and lowers the troponin level required for a diagnosis in female patients. Historically, these less common attacks, which often arise from childbirth, intense exercise or emotional stress, were classified as less serious and treated less urgently, leading to delayed care and poorer outcomes for women. The reclassification aims to ensure that women receive accurate diagnoses and appropriate treatment from the outset, a shift described by British Heart Foundation chief scientific officer Prof Bryan Williams as a “radical shift” that could be “life‑changing for huge numbers of women”.

The overhaul addresses a systematic bias that has long disadvantaged women in cardiac care. Previous protocols required women’s troponin levels – a protein released when heart muscle is damaged – to meet the same threshold as men’s before a heart attack could be confirmed, causing many female cases to be missed. By reducing this threshold, clinicians can identify myocardial injury earlier, particularly for attacks caused by arterial tightening, tears or emboli rather than the classic clot‑blocking mechanism that dominates “type 1” heart attacks. The updated categories also clarify the underlying cause of each event, enabling targeted therapies such as treatments for arterial spasm or interventions specific to SCAD, which accounts for 80 % of its cases in women and often occurs during or after pregnancy. Experts argue that aligning diagnostic criteria globally will eliminate the “unintended systematic bias against women” that has persisted for decades.

Implementation of the new definition will require worldwide adoption across emergency departments and cardiology units, a task led by Prof Nicholas Mills of the University of Edinburgh, who chaired the international taskforce that drafted the guidelines. Mills emphasised that the consensus represents the first truly global approach to describing, classifying and communicating heart attacks, and that its success hinges on rapid dissemination and training of healthcare professionals. If applied consistently, the standards could reduce fatal delays, improve patient understanding of their condition, and ultimately lower mortality rates for women worldwide. The guidelines, published in the European Heart Journal, signal a broader shift toward gender‑responsive medicine and set a precedent for future revisions of other disease definitions to address long‑standing inequities.

⚡ Effects Interpreter