Not the default patient
How cardiovascular medicine was built around men, and why the system is only now learning to ask better questions
Cardiovascular disease is the leading cause of death among women globally, yet for decades, the research, funding, and treatment pathways shaping cardiac care have been built largely around male populations.
Diane Wrightson is the Chief Operating Officer of Women As One, a global nonprofit organisation advancing women in cardiology through leadership development, mentorship, and access to professional opportunities. We invited Diane to contribute to FemTech Portugal’s Substack because her work sits at the intersection of two things we are committed to: closing the research gap and building the workforce that will close it.
What happens when we build cardiovascular health around women?
I often find myself coming back to a simple question. What would cardiovascular care look like if it had been built to include women from the start?
Not adapted later or corrected after the fact, but designed, from the beginning, with women in mind. Because today, we are tasked with rebuilding a system that was never designed for us in the first place.
My name is Diane Wrightson, and I am the Chief Operating Officer of Women As One, a global nonprofit organisation focused on advancing women in cardiology.
We support women cardiologists through leadership development, mentorship, education, and access to professional opportunities. At the heart of our work is a global community of over 3,000 women cardiologists, connected not just by speciality, but by a shared commitment to improving care for patients everywhere.
We do this because the gap is undeniable.
Women remain significantly underrepresented in the field of cardiology, and that gap does not just affect careers, it shapes the science we produce, the questions we ask, and ultimately, the care patients receive. There is now a growing body of evidence showing that when women lead clinical trials, more women are enrolled, and research becomes more representative and more useful, creating better patient outcomes.
The gaps we are still not talking about enough.
We often talk about women being underrepresented in leadership. That is true. However, the deeper issue is that women are underrepresented at every stage of the medical system.
In research design.
In clinical trials.
In guideline development.
In funding decisions.
And this creates blind spots.
Cardiovascular disease is the leading cause of death in women globally.
And still for decades, much of the research, funding, diagnosis, and treatment pathways have been based on male populations.
Women often present with different symptoms outside of the standard of what is taught in medical school. They may respond differently to treatments. They are more likely to be misdiagnosed or diagnosed later leading to worse outcomes.
One of the most overlooked gaps, in my view, is not just representation, but who gets to ask the questions in the first place. When the people designing research do not reflect the population they are studying, entire areas of need can remain invisible.
What is happening in clinical trials and drug development?
There is real progress here, and reason to stay cautious. We are seeing more attention on conditions that disproportionately affect women, and more intentional efforts to include women in trials. Regulatory bodies and funders are increasingly asking for sex specific analysis, which is a critical shift.
The EMPOWER CAD study is a good example, showing that when women are centred in both design and leadership, outcomes improve and questions we have long overlooked, like the role of reproductive history, start to surface.
Earlier prevention is finally becoming real, and for women, that matters most where risk is still too often missed. The VESALIUS-CV trial showed that Amgen’s PCSK9 inhibitor evolocumab (Repatha) reduced the risk of a first major cardiovascular event by about 25% in high-risk patients without prior heart attack or stroke. Around 43% of participants were women.
At the same time, the WARRIOR trial reminds us that we do not yet have the right treatments for many women with non-obstructive disease, and perhaps most importantly, emerging work in diagnostics is showing that we may not even be identifying heart disease accurately in women today.
Who is shaping this space right now?
One of the most encouraging shifts is that change is coming from multiple directions at once.
Organisations like the American College of Cardiology, the American Heart Association, and The European Society of Cardiology are creating more space for women in leadership and research.
In Portugal, there are encouraging signs of this momentum building. The Sociedade Portuguesa de Cardiologia (SPC) collaborated with the Portuguese Society of Gynaecology, the Portuguese Society of Obstetrics and Maternal-Fetal Medicine, and others to publish a consensus document specifically focused on women's cardiovascular health, Saúde cardiovascular da mulher, a meaningful step toward cross-disciplinary coordination. The SPC has since developed a Strategic Plan for Cardiovascular Health in Portugal, aligned with the European Society of Cardiology, establishing working groups across priority areas, although a dedicated focus on sex-specific research and women's representation within that plan remains an open question.
Industry is recognising that more inclusive research leads to better products and better outcomes. Patient advocates are pushing for change and globally, we are seeing networks form that are focused not just on advancement, but on reshaping the field itself.
Women leading trials.
Women building registries.
Women redesigning care pathways.
These are not abstract possibilities, they are the questions FemTech Portugal is actively bringing into the Portuguese context. Our upcoming event, Mind the Research Gap, on 29 April in Lisbon, brings together voices from research, pharma, and drug development to ask exactly this. If you are based in Portugal and this resonates, we would love to see you there: https://luma.com/knho1pb8
What I am watching closely
If I had to point to a few things that could meaningfully shift the landscape over the next few years, it would be these.
First, who leads the research. Not just who participates in trials, but who designs them. Leadership at this level changes everything downstream.
Second, how we use data. There is huge potential in better use of real-world data and more granular analysis of sex and gender differences, but only if we ask the right questions. AI is shifting the landscape here.
Third, how we build the workforce. If we continue to lose women at key transition points in their careers, we will continue to reproduce the same gaps. Supporting women to stay, lead, and thrive in cardiology is not a side issue. It is central to progress.
What innovation could really look like
When people think about innovation in healthcare, they often think about new drugs or technologies, but some of the most important innovations are quieter.
It is about how we design systems.
What if we built clinical trials that reflected real patient populations from the start.
What if leadership pathways were transparent and accessible.
What if mentorship and sponsorship were not informal or exclusive, but structured and intentional.
What if we recognised that better care for women improves care for everyone.
That is what the evidence shows. When we bring more diverse perspectives into medicine, we do not just make it more equitable. We make it better.
We are at an inflection point
There is more awareness than ever before. More data. More conversation. What gives me optimism is not just the recognition of the problem, but the number of people actively working to solve it.
Across research, industry, and clinical practice, there is a growing understanding that we cannot continue to build healthcare on partial knowledge. We need to design it with intention, and we need to support the people who are changing the system, connect them to opportunity, and help ensure their work reaches the patients who need it most.
When we invest in women in cardiology, we are not just changing careers. We are changing care. If you are working in women’s health, research, or innovation, this is a moment to pay attention. Not just to what is being built, but to who is building it. And to ask, honestly, whether the systems we are part of are designed to include the people and perspectives we need.
Diane Wrightson is COO of Women As One, a global community of over 3,000 women cardiologists working to improve care for patients everywhere. Learn more at womenasone.org.
FemTech Portugal is building the infrastructure for women’s health innovation in Portugal. If this piece resonated with you, join the conversation: https://luma.com/knho1pb8
FemTech Portugal is a non-profit building a collaborative ecosystem to accelerate women’s health innovation in Portugal. If you believe women’s health deserves to be taken seriously on its own terms, this community is for you.
Join the FemTech Portugal community on Substack.
FemTech Portugal Team | Samantha, Isabel & Lesley
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