Rethinking the “Widowmaker”

The term “widowmaker,” commonly used to describe a severe blockage in the left anterior descending (LAD) artery of the heart, is deeply embedded in the medical vernacular. The phrase often evokes the image of a catastrophic event, typically a sudden cardiac death, which leaves a woman abruptly and unexpectedly widowed. This term is a remnant from a time when cardiovascular disease (CVD) was viewed as a predominantly male issue, and this viewpoint articulates that this jargon is not only outdated but also inherently sexist and fails to reflect the ominous threat that CVD poses to both men and women.

Historically, CVD has been considered a male-dominated issue, with clinical research and trials often excluding women or failing to analyze gender-specific outcomes.¹ This male-centric view has contributed to the widespread use of terms such as widowmaker, implying that CVD primarily affects men. However, this notion is increasingly contradicted by mounting evidence demonstrating that women are equally, if not more, susceptible to CVD and its conventional risk factors.² In fact, emerging data have revealed recent trends that heart disease is now the leading cause of death for women in the United States, responsible for approximately 1 in every 5 female deaths.³ Despite this, women are less likely to be diagnosed, often receive less aggressive management strategies, and have suboptimal outcomes compared with men.⁴

The term widowmaker is inherently gendered and is not only obsolete but also excludes a significant number of women who suffer from acute coronary syndromes and the families who mourn their loss. Moreover, the term reinforces a pervasive stereotype that can contribute to the obfuscation of heart disease in women, who often present with atypical symptoms that are different from those presented by men, often leading to delays in diagnosis and treatment.⁵ The use of gendered language in the medical lexicon can adversely perpetuate these disparities by reinforcing the misconception that heart disease is chiefly a male problem.

For instance, we describe a case of a 28-year-old Caribbean-Black woman who presented with typical angina. Her electrocardiogram revealed a Wellens-type pattern characterized by biphasic T waves in the anterior leads. Urgent coronary angiography revealed a 95% critical proximal LAD stenosis, a classic presentation often referred to as the dreaded widowmaker lesion (Figure 1). This case highlights that such severe coronary artery disease does not solely affect men and underscores the need for inclusive and accurate terminology that reflects the profound impact of heart disease on women.

Figure 1.

The Patient’s Primary Percutaneous Coronary Intervention

(A) A straight-cranial cineangiographic frame illustrating a 95% critical proximal left anterior descending (LAD) artery stenosis encircled in red. (B) Successful drug-eluting stent (DES) insertion in the American College of Cardiology/American Heart Association (ACC/AHA) type B lesion with a good angiographic result and no complications.

Language shapes perception, and the use of gendered terms such as widowmaker can have a negative toll on clinical practice. Research has shown that gender bias in medicine can lead to gross disparities in management of CVD; for example, women are less likely than men to receive timely treatment for heart attacks, are less likely to be referred for cardiac catheterization, and are less likely to be prescribed statins and other preventive therapies.⁵ Furthermore, the use of such language can deleteriously affect patient perceptions and self-awareness. Women are less likely to recognize the signs and symptoms of a heart attack, in part because they do not see themselves as being principally at risk.⁵ The term widowmaker fortifies this perception, potentially leading to untimely delays in seeking treatment and worse outcomes.

The move toward more inclusive terminology is crucial for improving patient care and outcomes. Terms such as widowmaker should be imperatively replaced with language that appropriately reflects the condition and its impact on all patients, irrespective of gender. For instance, the term “critical LAD stenosis” or “acute LAD occlusion” can define and characterize the angiographic finding aptly without the misgendered implications. Health care professionals should be encouraged to use language that reflects the reality of CVD as a pernicious threat to both men and women and help to resolve the gender stereotypes that contribute to disparities in cardiovascular care.

Take-Away Messages

The term widowmaker is a relic of a time when cardiovascular disease was mistakenly perceived to be a predominantly male problem. Heart disease is the leading cause of mortality for both men and women, and the language we use to describe this condition should reflect that reality. Gendered terms not only perpetuate harmful stereotypes but also contribute to disparities in the diagnosis and treatment of heart disease. By adopting more inclusive and accurate terminology, we can improve the care of all patients with cardiovascular disease and ensure that no one is overlooked or underestimated based on gender. The time has come to retire the term widowmaker and embrace language that promotes gender equality in cardiovascular care.

Funding Support and Author Disclosures

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.