A blood pressure screening conducted during National Women’s Health Week highlights the importance of cardiovascular prevention and early detection among women. Image courtesy of the Centers for Disease Control and Prevention (CDC) Public Health Image Library (PHIL), ID #7865. Public domain.
Alexis Corso is a biology major with a minor in Spanish, and she is a 2025-26 Health Care Ethics Intern at the Markkula Center for Applied Ethics at ÌÇÐÄÆƽâ°æ. Views are her own.
Do you know the number one cause of death among men? If you said heart disease, you would be correct.
What about the number one cause of death among women? It is also heart disease.
Sixty eight percent In today’s healthcare system, women are at a huge disadvantage when it comes to cardiovascular disease (CVD). Underrepresentation of women in cardiovascular research fosters injustice by reducing the quality of care women receive and creating unequal outcomes.
How Do Systematic Flaws Create Injustices?
It wasn’t until the that it became law for women to be included in scientific research. Underrepresentation results in a lack of knowledge, which can have deadly impacts in clinical and pre-hospital settings. In the event of a cardiac arrest,. People are uncomfortable with performing CPR on a person with breasts, likely due to the lack of representation and training in most CPR classes.
Recent studies seek to analyze . Many point to the mistrust women have in the healthcare system due to generational trauma from unethical research and care. Experienced sexism causes women to be skeptical of providers, and doubt that their voices will be heard. Not only do women tend to avoid participation, but providers avoid getting them involved. Many women don’t get the same opportunities or information about participating in research as men, and providers are less likely to advertise research to women.
Women have proportionally smaller hearts than men, and recent studies have shown that the way myocardial infractions develop in female bodies are vastly different than in males. . Treatment of CVD wasn’t created for female patients, which is likely why they are .
The Real Impacts of Bias
was 48 when she had her first heart attack. After a night of chest pain, low oxygen readings, and her arms feeling heavy, she knew she had to go to the doctor. Despite her concerns, she was dismissed by three different doctors who misdiagnosed her with anxiety or acid reflux. At the ER when Heather asked for an angiogram, the doctor said: “There’s nothing wrong with your heart, I don't know why you're here.”
A week later, she felt intense pain in her chest and collapsed in her bathroom. At the hospital, an angiogram revealed a piece of plaque in her arteries had broken off and clotted, causing a heart attack. A stent was placed in her right coronary artery, and although doctors also found a plaque build up in her left coronary artery they decided not to place a stent there.
Ten days later, Heather felt pain in her chest again, which was dismissed by her doctor. She had another heart attack two nights later. Then a pacemaker was inserted, however the pain didn’t cease when she went home. Although doctors told her she was fine, she had another heart attack at the hospital, and then five more that night. Finally they decided they needed to place another stent.
Heather now advocates for women in cardiovascular care, hoping women are taken more seriously when presenting with heart attack symptoms.
Striving to Incorporate Justice
Justice seeks to create fairness in society, reduce inequality, and promote equal opportunity. Social justice in particular supports analyzing and improving systemic injustices. Heather Bardeleben was not only treated unjustly as an individual, but this treatment reflects the systemic bias which leaves women behind when it comes to cardiovascular health. When she sought out a second opinion she got no new information. When she advocated for herself, her voice went unheard.
When applying the justice framework to this issue, it becomes essential that healthcare systems take steps to improve research around women’s CVD. Distributive justice in particular aims to allocate resources fairly and equitably. The NIH should make funding conditional on proportional enrollment of women in CVD studies which accurately reflects the population. Funding for specific research on CVD in women should be prioritized, and medical education should be reformed so that physicians are aware of varying presentation of CVD and systemic biases.
These solutions would force the NIH and other groups which support research to allocate more money and resources to women’s CVD, which could cause a potential strain. However, this is necessary in order to overcome barriers that put women at risk. Conditional and increased funding supports justice, as it aims to better support a group which is currently disadvantaged. Implementation of these solutions would improve outcomes for thousands of women, promote more thorough research, and enhance medical education.
Principlism as a Guide
Another key ethical component in the analysis of this issue is the principles which guide healthcare providers so that they serve patients the best they can. Nonmaleficence describes the duty to “do no harm” to a patient. When a physician misdiagnoses a patient, the effects are potentially deadly. As seen in the case of Heather Bardeleben, her multiple misdiagnoses resulted in nearly losing her life from a heart attack.
The current lack of research and medical education around CVD in women leads to misdiagnoses. Misdiagnosing a patient creates harm, increased risk, and delayed care. This directly violates the principle of nonmaleficence.
A solution to overcome this is to implement protocols which protect women from misdiagnoses. It should be required to order cardiovascular imaging for women who present with potential CVD symptoms before diagnosing them as anxiety or reflux. One must address the concern that this would cost the healthcare system more money and time due to having to provide imaging to more patients. Medical staff are constantly under stress due to overloads on the system. This strain can cause decreased quality of care overall and have negative impacts on provider mental health. However, this is of less importance than the ethical responsibility of the healthcare system and providers to uphold nonmaleficence. The barriers in healthcare which put those at a disadvantage must be addressed before ensuring the complete stability of the system as a whole.
Similarly, beneficence describes the ethical obligation to act for the benefit of others by promoting well-being and preventing harm. Inaccurate research and lack of specific training creates a barrier in providing optimal care to women. In order to better uphold beneficence in the future, insurance companies should be held accountable to provide coverage for preventative screenings. Current healthcare providers should also go through specific training about how CVD can present differently in women, as well as anti-bias training. In medical schools, this training and education should also be implemented.
Not only would these solutions create better outcomes for women with CVD, but they would create a better healthcare system as a whole with less bias and more openness to implementing social justice.
Women are not simplistic additions to men, their bodies are complex systems of their own which deserve the proper research, quality of care, and advocacy. The best way to implement social justice and improve equality is to start by including more women in research, as well as researching female specific risk factors. We must also remove biases in clinical settings and educate people about women’s cardiovascular health. Without these changes, more women will continue to be misdiagnosed, receive improper treatment, and die. It is only when the healthcare system truly exemplifies justice and its core ethical principles that it will treat women as equal patients who should be listened to and treated with the highest quality of care.