Canadian Journal of Cardiology

Sex and Gender Bias as a Mechanistic Determinant of Cardiovascular Disease Outcomes

Published:September 15, 2022DOI:


      Defined as a prejudice either for or against something, biases at the provider, patient, and societal level all contribute to differences in cardiovascular disease recognition and treatment, resulting in outcome disparities between sexes and genders. Provider bias in the under-recognition of female-predominant cardiovascular disease and risks may result in under-screened and under-treated patients. Furthermore, therapies for female-predominant phenotypes including non-obstructive coronary artery disease and heart failure with preserved ejection fraction are less well researched, contributing to under-treated female patients. Conversely, women are less likely to seek urgent medical attention, potentially related to societal bias to put others first, which contributes to diagnostic delays. Furthermore, women are less likely to have discussions around risk factors for coronary artery disease compared to men, partially because they are less likely to consider themselves at risk for heart disease. Provider bias in interpreting a higher number of presenting symptoms, some of which have been labeled as ‘atypical’, can lead to mislabeling presentations as non-cardiovascular. Furthermore, providers may avoid discussions around certain therapies including thrombolysis for stroke, and cardiac resynchronization therapy in heart failure, as it is incorrectly assumed women are not interested in pursuing options deemed more invasive. To mitigate bias, organizations should aim to increase the visibility and involvement of women in research, health promotion, clinical and leadership endeavours. More research needs to be done to identify effective interventions to mitigate sex and gender bias and the resultant cardiovascular outcome discrepancies.

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