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A split-screen image showing a man and a woman with a 3D anatomical heart in the center.

Genetically, there’s almost no difference between men and women; 98.5% of our DNA is the same. But evidence shows that heart disease often develops — and presents — differently in women than in men. 

Why? 

Research points to several key reasons, including differences in physiology, risk factors, and symptoms.

When it comes to physiology, women’s hearts are, on average, smaller than men’s. And the variations go beyond size. Women’s heart muscles are typically stiffer than men’s,1 and the amount of time it takes for the heart to recharge after each beat is typically longer in women than in men.2

For adults in the United States, heart disease continues to be the leading cause of death.3

Beyond size

Anatomical differences between men's and women's hearts

1. Muscle makeup

Women’s heart muscles are generally stiffer.1

2. Small vessels

Women tend to have smaller blood vessels5 and are more likely to experience chest pain without arteries being blocked.6

3. Charging up the heart

Women’s hearts can take longer to “recharge” after each beat.2

4. Valve variables

Mitral valve prolapse is more often diagnosed in women than in men.7

5. Fibrosis pattern

Men’s hearts tend to develop fibrosis — essentially scarring — more than women’s. Some medical research suggests hormone differences may play a role.8

Representation in research

Medtronic strives to ensure representation in clinical health tech studies. One example is our recent SMART study, which focused on a therapy for aortic stenosis, a potentially deadly heart condition. The study included men and women with small annuli, or heart valves. But women typically have smaller heart valves than men — so nearly 90% of the patients in the study were women.4

The research compared the performance of the Medtronic Evolut™ transcatheter aortic heart valve replacement (TAVR) system against the Edwards Sapien™ TAVR system in patients with severe aortic stenosis and smaller heart valves. 

The findings showed the Medtronic Evolut™ TAVR system performed better, particularly in post-procedure hemodynamics, or blood flow.4

Picture of the Medtronic TAVR heart valve
  1. St Pierre SR, Peirlinck M, Kuhl E. Sex matters: a comprehensive comparison of female and male hearts. Front Physiol. 2022;13:831179. Published 2022 Mar 22. doi:10.3389/fphys.2022.831179.
  2. Ravens U. Sex differences in cardiac electrophysiology. Can J Physiol Pharmacol. 2018;96(10):985—990. Published 2018 July 12. doi:10.1139/cjpp-2018-0179.
  3. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation. 2023;147(5):e93-e621. Published 2023 Jan 25. doi:10.1161/CIR.0000000000001123.
  4. Herrmann HC, Mehran R, Blackman DJ, et al. Self-expanding or balloon-expandable TAVR in patients with a small aortic annulus. NEJM 2024;390:1959—1971.
  5. Betai D, Ahmed AS, Saxena P, et al. Gender disparities in cardiovascular disease and their management: a review. Cureus. 2024;16(5):e59663. Published 2024 May 5. doi:10.7759/cureus.59663.
  6. Zijlstra LE, Bootsma M, Jukema JW, Schalij MJ, Vliegen HW, Bruschke AVG. Chest pain in the absence of obstructive coronary artery disease. Int J Cardiol. 2018;280:19-28. Published 2018 Oct 1. doi:10.1016/j.ijcard.2018.09.103.
  7. Avierinos J-F, Inamo J, Grigioni F, Gersh B, Shub C, Enriquez-Sarano M. Sex differences in morphology and outcomes of mitral valve prolapse. Ann Intern Med. 2008;149(11):787-795. Published 2008 Dec 2. doi:10.7326/0003-4819-149-11-200812020-00003.
  8. Ventura-Clapier R, Piquereau J, Garnier A, Mericskay M, Lemaire C, Crozatier B. Gender issues in cardiovascular diseases. Focus on energy metabolism. Biochim Biophys Acta. 2020;1866(6). Published 2020 Feb 11. doi:10.1016/j.bbadis.2020.165722.