ISLAMABAD: Heart disease is killing more women in Pakistan than previously understood, with female patients experiencing higher mortality rates, more severe symptoms and delayed diagnoses compared to men, according to a landmark hospital-based study published this week.

The paper, ‘Burden of cardiovascular disease in women: data from Pakistan’s largest cardiac hospital network,’ was released in npj Women’s Health this month and analyzed data from over 14,800 patients treated at the National Institute of Cardiovascular Diseases (NICVD). It found that women with heart conditions are more likely to die than men, despite presenting at a younger age in some cases and with more complex symptoms.

“Women are diagnosed at a later stage, have delayed surgical referrals, and have poorer post-operative outcomes than males,” the researchers wrote. “There is a scarcity of data from South Asia due to underrepresentation of women in studies, which limits the development of evidence-based guidelines.” 

The study used prospective data collected from three patient registries, valve disease, coronary catheterization, and structural interventions, between October 2022 and June 2024. It discovered that females are more likely than males to suffer from valvular heart disease (VHD) and present at a considerably younger age. 

Females also had a higher likelihood of mitral valve disease than males, who were more likely to have aortic valve disease. Rheumatic heart disease was the leading cause of all left-sided VHD. 

Among women admitted with acute coronary syndrome (ACS), the study noted a “significantly higher prevalence of diabetes and hypertension” and that women experienced “a significantly higher rate of death, longer door-to-balloon time, and total ischemic time.”

The authors stressed that gender disparities in cardiac care in Pakistan are systemic, with women often excluded from clinical trials, underdiagnosed in hospitals and referred for surgical or interventional treatment far too late.

“Understanding the burden and presentation of cardiovascular disease in women is crucial to improving outcomes,” the paper stated, warning that Pakistan lacks gender-disaggregated cardiac data on a national level.

Heart disease is the leading cause of death worldwide for women, and the burden is rising fastest in low- and middle-income countries. In Pakistan, non-communicable diseases account for over 60 percent of all deaths, according to the World Health Organization. Yet gender-specific health data remains scarce, and preventive screening for women is rarely prioritized.

The authors called for improved surveillance, early detection programs and “urgent inclusion of women in cardiovascular clinical research” to address the growing crisis. 

“The development of targeted awareness programs and community-based screening could play a critical role,” they wrote.

Pakistan’s public health system remains underfunded, and most cardiovascular care is concentrated in a few urban centers like NICVD. Experts warn that without immediate policy intervention, gender inequities in care could worsen as risk factors like diabetes, obesity, and hypertension continue to rise.

The researchers concluded:

“Tailored public health policies and investments in gender-sensitive health care delivery are urgently needed to reduce the cardiovascular disease burden in women.”