Background <p>Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with men and women experiencing distinct differences in risk, symptom presentation, and health outcomes. Despite established evidence of these differences, women remain underrepresented in cardiovascular research, leading to persistent disparities in clinical care and outcomes.</p> Main body <p>Important sex differences in CVD risk and risk factors exist. For example, women face a disproportionately higher CVD risk from metabolic disorders such as diabetes. However, the underlying reasons have not been fully explained. Women are also more likely to present with atypical or non-classic CVD symptoms, resulting in under-recognition, diagnostic delays, and less intensive management. Despite this, most current research findings and guidelines are based predominantly on males, limiting their relevance for women.</p> <p>The lack of sex-specific evidence extends to risk prediction models and treatment approaches. Existing models have not considered women’s specific risk factors. Prevention and treatment strategies often rely on “one-size-fits-all” standards that fail to address women’s unique needs. Addressing these gaps requires clinical research intentionally designed to incorporate sex differences at every stage, from participant recruitment and risk stratification to the development of tailored prediction tools and therapies, and prioritize sex-specific questions.</p> <p>Increasing women’s representation as both participants and principal investigators in clinical trials is essential; evidence shows that studies led by women are more likely to enroll female participants. Promoting women’s leadership can help ensure that women’s perspectives and needs are fully integrated into cardiovascular research and healthcare.</p> Conclusions <p>Achieving equity in cardiovascular health requires the integration of sex-specific perspectives across research, risk assessment, prevention, treatment, and leadership. These efforts are essential to close persistent knowledge gaps and improve the quality and equity of cardiovascular care for all.</p>