Womens heart health in Scotland: aligning policy and multidisciplinary clinical practice to reduce cardiovascular disease inequity

Cardiovascular disease (CVD) remains the leading cause of death among women in Scotland, with persistent inequalities in prevention, diagnosis and outcomes1. Women experience delayed diagnosis, under-recognition of risk and reduced access to evidence-based care, while sex-specific factors such as adverse pregnancy outcomes and menopause are not consistently incorporated into cardiovascular (CV) risk assessment or prevention2. National commitment to women’s health was formalised through a government programme in 2019–2020, leading to publication of a dedicated Women’s Health Plan for 2021–2024, followed by a second phase released in January 2026 that maintains a strong focus on cardiovascular disease3,4,5.

To describe how a national, collaborative approach translates policy into frontline prevention and care for women’s CV health through multidisciplinary practice.

A national women’s health programme adopted a co-production approach, bringing together clinicians, policy leads, third sector organisations and women with lived experience to guide policy development and service improvement5. A central women’s health group provided strategic leadership, identified gaps in service provision and aligned actions across policy areas, supported by themed sub-groups with specialist expertise. A dedicated ‘heart health’ subgroup reviewed epidemiological data, clinical evidence and stakeholder perspectives to develop and prioritise recommendations, which informed national women’s health policy and implementation planning (Figure 1).

The policy framework positioned CVD as a priority condition for women and initiated actions across awareness, prevention, workforce education, service design and research. Implementation has included revision of clinical guidance and care pathways to better reflect sex-specific risk factors, increased emphasis on prevention across the life course, and incorporation of pregnancy-related complications into long-term cardiovascular risk management. Actions addressing menopause management and contraceptive use in CVD and awareness of the relationship between pregnancy and future CV risk have been introduced or are under active implementation. Workforce education and service development are ongoing across primary care, obstetrics, gynaecology and cardiovascular services (Table 1).

Improving women’s heart health requires sustained collaboration between clinicians and policymakers and third-sector organisations supported by patient partnerships. A coordinated national approach can translate evidence into phased system-level change, addressing long-standing inequities while embedding sex-specific cardiovascular prevention and care across health services. This experience offers transferable lessons for advancing women’s cardiovascular health through integrated policy and clinical leadership.

On behalf of the Scottish Government's Heart Disease Task Force Women's Heart Health subgroup