New heart attack definition corrects decades of under-diagnosis in women
Rule ChangesWorld's four leading cardiology groups agree on first universal definition with sex-specific blood test thresholds
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Overview
Updated 1 hour agoFor decades, the blood test for heart attacks used a single threshold for every patient. That threshold caught nearly all men having heart attacks but missed some women, because women naturally carry lower levels of the heart-injury protein troponin. The world's four leading cardiovascular organizations just agreed on the first universal definition of a heart attack, and it corrects that bias.
The new guidelines, presented at the European Society of Cardiology congress in Munich, elevate three heart attack types that are up to ten times more common in women to the same classification tier as clot-caused attacks. They also require sex-specific troponin thresholds in emergency departments. For the first time, spontaneous coronary artery dissection, coronary artery spasm, and coronary embolism will be treated as first-class diagnoses.
Why it matters
Millions of women have had heart attacks missed by tests calibrated to men; the new definition should catch them earlier and save lives.
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People Involved
Organizations Involved
Europe's leading cardiovascular medical society, representing more than 100,000 cardiology professionals.
U.S. medical society representing cardiovascular professionals.
U.S. nonprofit focused on cardiovascular health and research.
International federation of cardiology organizations, leading the global fight against cardiovascular disease.
UK charity funding cardiovascular research and supporting heart disease patients.
Timeline
August 2018 September 2026
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Coverage highlights impact on women's diagnosis
Today MediaReports detail how sex-specific troponin thresholds and upgraded heart attack types correct decades of under-diagnosis in women.
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Fifth Universal Definition presented at ESC Congress
GuidelineFour leading cardiology organizations agreed on the first universal heart attack definition in Munich.
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Fourth Universal Definition of MI published
GuidelineEstablished the distinction between myocardial injury and infarction, setting the stage for the Fifth Definition.
Historical Context
3 moments from history that rhyme with this story — and how they unfolded.
Go Red for Women campaign (2004)
The American Heart Association launched Go Red for Women to raise awareness that heart disease is the leading killer of women. The campaign highlighted that women were under-diagnosed and under-treated compared to men.
Increased awareness of women's heart disease risk and atypical symptoms.
Raised awareness but didn't change diagnostic criteria, which remained calibrated to men.
Two decades of awareness campaigns highlighted the problem of under-diagnosis in women, but the new definition is the first structural fix to the diagnostic criteria themselves.
Fourth Universal Definition of MI (2018)
The Fourth Universal Definition introduced the distinction between myocardial injury and myocardial infarction, refining diagnostic criteria. It was the first to acknowledge that troponin elevation alone doesn't equal a heart attack.
Clinicians gained clearer guidance on when to diagnose a heart attack versus other causes of troponin elevation.
Set the framework that the Fifth Definition would build on, including the recognition that diagnostic criteria needed refinement.
The Fifth Definition directly builds on the Fourth, adding sex-specific thresholds and elevating under-recognized heart attack types.
Recognition of SCAD as a distinct condition (2010s)
Spontaneous coronary artery dissection was historically misdiagnosed or missed entirely. Research in the 2010s established it as a distinct condition predominantly affecting women, often during or after pregnancy.
SCAD became a recognized clinical entity with its own diagnostic criteria.
Its recognition paved the way for its inclusion in the Fifth Universal Definition as a first-class heart attack type.
SCAD's elevation in the new definition reflects a broader shift toward recognizing that heart attacks have multiple causes, not just the classic clot-based mechanism.
