JAHA Go Red for Women Spotlight 2026

February is Go Red for Women month, and the Spotlight in this issue of the Journal of the American Heart Association (JAHA) features articles which further our understanding of cardiovascular disease (CVD) and stroke in women. These articles evaluate female‐specific or sex‐related differences in the clinical presentation, diagnosis, care and outcomes of CVD in addition to several articles that address the sex‐specific pathophysiology of disease.

Sex differences in clinical presentation are important to understand for timely and accurate diagnosis. Zamen et al found no sex differences in the presentation or outcomes of spontaneous coronary artery dissection, but found that women had higher rates of hypertension, coronary tortuosity and fibromuscular dysplasia. ¹ In ST elevation myocardial infarction, time from symptom onset to reperfusion is critical. Huang and colleagues found that women had a longer prehospital delay which was due to delayed call to emergency medical services. ² This highlights the need for ongoing public health messaging regarding symptom recognition and early activation of emergency medical services among women. Bossone reported that compared with men, women with Type A and Type B aortic dissection presented later and were more likely to be managed medically than managed surgically. ³ Women with Type A aortic dissection had greater mortality compared with men.

Sex differences in outcomes may also vary with age. Two studies in this Spotlight focus on younger populations. Leppert and colleagues found no difference in stroke severity between women and men among young adults age 18 to 55 years. ⁴ Among a cohort of similar age patients hospitalized with first myocardial infarction (MI), Satish and colleagues found mortality was higher in women with ST elevation MI and non‐ ST elevation MI and that women received fewer cardiovascular procedures. ⁵ Additionally, this Spotlight includes the report: Age‐ and Sex‐ Specific Distribution and Reference Values of Coronary Artery Calcium in a Large Asymptomatic Japanese Cohort. ⁶ The accompanying editorial highlights the importance of tailoring coronary calcium scores to not only sex and age but also race. ⁷

Much research focuses on understanding complex psychosocial factors and how they influence the development of risk factors, disease, disease and symptom manifestation and outcomes of CVD in women. In this Spotlight, Vaccarino and colleagues evaluated stress–induced myocardial ischemia using myocardial perfusion imaging at rest and after mental stress using a speech task. They demonstrate that among a cohort of mid‐life individuals with a recent MI, the incidence of mental stress induced myocardial ischemia was doubled in Black women and was not explained by psychosocial risk factors. ⁸ This is particularly important given the rising incidence of premature MI in women. These findings suggest that psychological stress is related to the premature cardiovascular risk and mortality of Black women.

Many studies have found sex differences in the receipt and outcomes of procedures for the treatment of CVD. Two studies in this Spotlight report on the safety and efficacy of procedures among women. Women referred for transcatheter tricuspid valve replacement had higher risk profiles than men but had no difference in short‐term outcomes following the procedure. ⁹ Ribatti et al reported on the safety, efficiency and efficacy of pulse‐field versus thermal‐based ablation technologies for atrial fibrillation. ¹⁰ These are important findings given that women are often underrepresented in studies evaluating new procedures and technologies.

Our understanding of pregnancy related complications continues to expand as we aim to improve short‐term maternal and fetal health as well as reduce long‐term cardiovascular risk. Saito and colleagues provide a prediction model of hypertensive disorders of pregnancy based on home blood pressure monitoring. ¹¹ Additionally, Lip et al found that diverse, multiple or recurrent pregnancy‐related complications have higher risk of maternal CVD and emphasized that women experiencing such complications should receive a comprehensive cardiovascular risk assessment and targeted prevention. ¹²

Several studies in this Spotlight explore pathophysiological mechanisms of disease in women or verify prior findings among men in female populations. Much research on the cardiovascular effects of substance use is limited to male populations. Adding to the literature, Riley and colleagues found that sustained methamphetamine and amphetamine use is associated with left ventricular diastolic dysfunction in women. ¹³ In a study among smokers, Akl and colleagues found a greater prevalence on interstitial myocardial fibrosis among women compared to men, identifying a potential sex‐specific mechanism by which smoking results in CVD in women. ¹⁴ Rahunen et al found that the role of 4β hydroxycholesterol in overweight‐and obesity‐induced hypertension is specific to women, offering a mechanistic explanation for the observed greater association between increased BMI and hypertension in women. ¹⁵

The study by Cho and colleagues, Misperception in Heart Failure Phenotyping: Moving Beyond the Chamber to the Myocardium, offers new insights into labeling of heart failure phenotypes. ¹⁶ The authors found that geometry‐adjusted left ventricular ejection fraction, correcting for relative wall thickness, and left ventricular global longitudinal strain were greater predictors of mortality than traditional left ventricular ejection fraction among patients hospitalized with acute heart failure, particularly among elderly women. The authors point out that these findings may call into question the diagnosis of heart failure with preserved ejection fraction, which is more common in women. Use of myocardial assessments rather than left ventricular ejection fraction may ultimately have implications for future research in heart failure therapeutics.

These articles present exciting findings and new insights into CVD and stroke in women. They provide future directions to further identify and address risk, improve diagnosis and treatment, develop new therapeutics and ultimately improve outcomes for women with CVD and stroke.

Disclosures

None.