PURPOSE OF REVIEW: To explore sex-specific dimensions of cardiovascular disease (CVD) by addressing key questions: (1) What is the true burden of CVD in women, and how does it compare with that in men across diverse populations? (2) Do risk factors for CVD differ between sexes in prevalence, biological impact, and prognostic significance? (3) Should we adopt sex-specific cardiovascular risk stratification tools to improve diagnostic precision in women? (4) Is there a need for earlier or more aggressive preventive strategies in women, particularly for those with sex-specific or predominant risk factors? RECENT FINDINGS: CVD remains the leading cause of morbidity and mortality among women worldwide. Despite advances in care, significant sex-based disparities persist in awareness, diagnosis, risk stratification, and treatment. Women often present with distinct biological and psychosocial risk factors that are underrecognized in standard assessments. Emerging data support the development of sex-specific tools and earlier interventions tailored to these differences. This review highlights the need for a more nuanced, sex-sensitive approach to CVD prevention and management. By reevaluating traditional risk frameworks and incorporating female-specific and underrecognized contributors, there is potential to improve outcomes and close the persistent care gap for women.