Analysis of the research used as a basis for clinical guideline development underscores the insufficient consideration of sex and gender in the primary evidence base informing the 2019 ESC guideline recommendations for chronic coronary syndromes. The underrepresentation of women in cardiovascular research and guideline development poses challenges for accurately discerning possible sex- and gender-specific effects and tailoring recommendations to diverse patient needs. Addressing these gaps requires explicitly integrating sex and gender considerations into study designs and guideline creation processes and promoting inclusivity to optimize clinical care provision and improve outcomes for all individuals affected by ischemic heart diseases.