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New heart attack definition corrects decades of under-diagnosis in women

New heart attack definition corrects decades of under-diagnosis in women

Rule Changes

World's four leading cardiology groups agree on first universal definition with sex-specific blood test thresholds

Today: Coverage highlights impact on women's diagnosis

Overview

Updated 1 hour ago

For 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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Key Indicators

3
Heart attack types elevated in classification
Coronary artery spasm, coronary embolism, and SCAD now sit in the same tier as clot-caused attacks.
80%
SCAD cases occurring in women
Spontaneous coronary artery dissection often happens during or shortly after pregnancy.
4
Cardiology organizations that agreed
ESC, ACC, AHA, and WHF signed the first universal heart attack definition.

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People Involved

Organizations Involved

Timeline

August 2018 September 2026

3 events Latest: Today
  1. Coverage highlights impact on women's diagnosis

    Today Media

    Reports detail how sex-specific troponin thresholds and upgraded heart attack types correct decades of under-diagnosis in women.

  2. Fifth Universal Definition presented at ESC Congress

    Guideline

    Four leading cardiology organizations agreed on the first universal heart attack definition in Munich.

  3. Fourth Universal Definition of MI published

    Guideline

    Established 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.

2004-present

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.

Then

Increased awareness of women's heart disease risk and atypical symptoms.

Now

Raised awareness but didn't change diagnostic criteria, which remained calibrated to men.

Why this matters now

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.

August 2018

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.

Then

Clinicians gained clearer guidance on when to diagnose a heart attack versus other causes of troponin elevation.

Now

Set the framework that the Fifth Definition would build on, including the recognition that diagnostic criteria needed refinement.

Why this matters now

The Fifth Definition directly builds on the Fourth, adding sex-specific thresholds and elevating under-recognized heart attack types.

2010s

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.

Then

SCAD became a recognized clinical entity with its own diagnostic criteria.

Now

Its recognition paved the way for its inclusion in the Fifth Universal Definition as a first-class heart attack type.

Why this matters now

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.

Sources

(9)