Insights Into Cardiovascular Disease in Women From the Framingham Heart Study

For much of the 20th century, cardiovascular disease (CVD) was viewed as a predominantly male condition, contributing to under-recognition and undertreatment in women. The Framingham Heart Study (FHS) fundamentally changed this paradigm by establishing that women experience a high lifetime burden of CVD and that traditional risk factors may have sex-specific effects. During nearly 8 decades of follow-up, FHS has demonstrated that women develop CVD later in life, but experience accelerated midlife accumulation of risk factors and substantial late-life morbidity, particularly from stroke and heart failure with preserved ejection fraction. FHS investigations further revealed that blood pressure, diabetes, adiposity, and lipid-related risk occur at lower biological thresholds in women and that ischemic heart disease is frequently different in presentation. Collectively, these findings define women's CVD as biologically distinct rather than a delayed manifestation of male disease, with important implications for sex-informed risk assessment, prevention, and clinical care.