Sex Differences in Cardiovascular Physiology and Pathophysiology - Chapter 12 - Sex Differences in Coronary Artery Disease

Cardiovascular disease is the leading cause of death in women in the United States. Although awareness of coronary artery disease (CAD) risk and presentation in women has increased over the last 3 decades, sex-related disparities persist. Women continue to be underrepresented in clinical trials, and this affects the accuracy of cardiovascular risk assessment models, diagnostic modalities, and treatments for this population. More women than men present with atypical symptoms during an acute coronary syndrome, and this may be attributed to a gender-specific pathophysiology of disease. Nonobstructive CAD and plaque erosion is more common in women who present with acute myocardial infarction compared to men. Further studies are needed to determine whether sex-based diagnostic modalities and therapy can improve the morbidity and mortality of women with CAD. However, until these studies are performed, it is imperative that the current, gender-neutral guidelines be applied for women just as for men. This chapter reviews the differences in awareness, risk factors, pathophysiology, clinical presentation, diagnostic evaluation, and management between men and women with CAD.