I'm a cardiologist. A 42-year-old mother of two came to my office complaining of jaw pain and crushing fatigue. She ran half-marathons. Her EKG was normal. Another doctor had sent her home with anxiety medication.
When I got her into the cath lab, I found severe microvascular disease — plaque choking the tiniest vessels of her heart, the ones standard angiograms routinely miss.
Her heart had been starving in silence while everyone told her she was stressed.
She is alive today. Too many women like her are not.
Heart disease kills more women than every cancer combined. And medicine is still diagnosing it through a male lens.
84% of cardiologists report having patients in the past year whose heart disease was misdiagnosed by another physician. Women with a STEMI heart attack have a 59% greater chance of being misdiagnosed compared to men. Women with an NSTEMI — 41% greater chance.
The reason is structural. For decades, we screened, tested, and treated women using a template built for men.
Men's heart attacks announce themselves — the crushing chest pain, the clutched fist, the Hollywood collapse. Women's hearts whisper. Crushing fatigue that feels like wearing a lead vest. Jaw pain written off as TMJ. Nausea blamed on a stomach bug. An ache between the shoulder blades blamed on a long week. Shortness of breath blamed on being out of shape.
For years, medicine called these "atypical" symptoms. They are not atypical. They are female-typical. Half of humanity is not a variant.
And the biology runs deeper than symptoms.
Women have smaller hearts and narrower coronary arteries. Plaque doesn't only clog the big highway vessels — it hides in the microvasculature, the tiny branches feeding the heart muscle itself. A woman can have a heart attack with a completely "clean" standard angiogram.
SCAD — spontaneous coronary artery dissection — occurs 90% of the time in women. Often young, fit women with zero traditional risk factors. It's the leading cause of heart attack in women under 50, accounting for roughly one quarter of all cases in that age group. Most doctors have never diagnosed one.
And some of the most dangerous cardiac risk factors are hidden in women's medical histories where no one thinks to look:
Preeclampsia or gestational hypertension doubles to quadruples lifetime heart disease and stroke risk. Pregnancy is the body's first cardiac stress test — and these complications are early warning sirens, not closed chapters.
Autoimmune disease — lupus, rheumatoid arthritis, psoriasis — far more common in women, turbocharges inflammation and plaque formation at any age.
Cardiovascular disease in women aged 20-44 is projected to surge nearly 50% by 2050.
The youngest patients in my practice keep getting younger.
What every woman should ask her doctor — and what every doctor should be asking:
"Given my pregnancy history, autoimmune status, and family history — what is my full cardiovascular risk?" If they don't ask about preeclampsia or gestational diabetes, volunteer it.
"Should I have an Lp(a) test and a coronary calcium score?" Standard cholesterol panels miss too much. Lp(a) is genetic, one-time, and most women have never been tested.
"My tests came back normal but my symptoms haven't stopped — what's next?" Normal stress tests and angiograms can miss microvascular disease, spasm, and SCAD. Persistent symptoms warrant coronary CT angiography or cardiac MRI.
And if something feels wrong — say these exact words to your doctor: "I am concerned this could be my heart."
That single sentence changes the workup. Do not soften it. Do not apologize for it.
80% of heart disease is preventable. But the playbook has to be built for female biology.
Two decades ago, I wrote one of the first books warning that heart disease was the number one killer of women and that medicine was diagnosing it through a male lens. It was recognized by First Lady Laura Bush at the White House during the early years of the national conversation about women's heart health.
I'm haunted by how much of that book I could republish today unchanged.
The science has advanced. The awareness has grown. But the gap between what we know and what happens in the exam room is still costing women their lives.
Share this with every woman you love — and every doctor who treats them. READ MORE: https://t.co/4LRugiY8q2
I’ve got to give some praise to @Marriott. My 20 year old is traveling and would either be on the road till 5am or need to find a hotel tonight. Most American hotels require you be 21 to check in. There are some that allow 20 year olds, but in the area she’s in those were not great options for a single 20 year old female. The Courtyard by Marriott near where she’ll be driving was the only hotel that was willing to make an exception for her.
I've been critical of Trump's Iran war decision, which from the beginning has lacked clear strategic objectives and failed to prepare for and mitigate significant risks.
But I reject Joe Kent's characterization of how this war came about. Israel has its interests, and like any nation, will pursue them. But the President of the United States has agency, made his own judgments about US interests, and fully owns the decision to go to war. If you disagree with it, he bears responsibility.
Kent's characterization -- consistent with his known extremist views -- echoes longstanding antisemitic tropes about shadowy cabals exerting undue influence. No. Israel is a country that pursues its interests. We don't have to agree with them. American citizens of any background have a right to advocate for the policies they support. Everyone can disagree with them too. But Presidents make decisions about using military force.
Despite my utter contempt for the cruel and dangerous Iranian regime, and support for the Iranian people's quest for freedom, I believe Trump erred to conduct this war, this way. More importantly on day 17, I am calling for him to declare victory based on the significant damage to Iran's power projection capabilities, and take an off-ramp before a lengthy conflict does serious harm to our broader strategic interests.
It is possible to do several things at once: oppose this war; hold the President responsible; recognize the evil of the Iranian regime; call for an end to the war now that significant damage has been done to Iran's ability to threaten its neighbors, and before broader damage to global U.S. interests is incurred; acknowledge that the U.S. and Israel are partners with many overlapping but also some divergent interests; and, avoid antisemitic tropes in making a case against the war.
Democrats who oppose this war don't need Joe Kent or his extremist views to make their case. They should not embrace him.
Hey @AlaskaAir you dropped the ball and couldn’t get us to Tokyo on the flights we booked months ago. We scrambled to find an airline who could, last minute, at a cost of 10K one way. Now we’re in Tokyo and find out you cancelled our return flight because we missed the flight out here (because you held us on the tarmac for 4 hours and we watched our flight depart without us). Now the hold times to reach a customer service agent are consistently 8+ hours. How does someone reach a human at your company?
Yes, a Jewish charity runs one of the biggest free Halal food distributions for Ramadan.
If that bothers you, I honestly don’t care.
In a crazy world, we look out for each other.
Proud of my @MetCouncil team.
You got to give lots of credit to Eileen Gu for responding brilliantly back to the reporter with great confidence.
She looked him in the eye said that was a "ridiculous perspective" without any hesitation or fear. 😁
✨History made✨
Today Karin Harjo became the first female coach to set a course at an Olympic alpine event. 👏
“We’re in 2026 and it’s the first time, and the reason is because of @MikaelaShiffrin . She set out to lift up women in sport - competitors, coaches, everyone behind the scenes. Through her greatness, she’s creating opportunities for women to rise and paving the path for those coming next.”
When Zohran Mamdani dares to say that “when the boot of the NYPD is on your neck, it’s been laced by the IDF,” there is no room for debate, no refuge in the tired alibi of “anti-Zionism.” It is unvarnished, unashamed antisemitism. May the voters of New York remember it tomorrow.