Sex differences in coronary artery disease

Myocardial infarction is the leading cause of death worldwide in men and in women. Nevertheless, cardiovascular diseases in women are still understudied, underdiagnosed and undertreated leading to poor outcomes and higher mortality rates. Important sex differences exist in coronary artery disease with a higher symptom burden, delayed presentation and treatment of women in the emergency department and more non-obstructive coronary artery disease on angiogram. Sex hormones influence hemostasis and platelet function, and women suffer more from major bleeding complications after coronary interventions. Moreover, cholesterol levels increase with age particularly in women and sex hormones might play an important role in the development and progression of atherosclerosis with an increasing cardiovascular risk for women after menopause. Women also have other unique sex-specific risk factors such as hypertensive disorders of pregnancy that are contributing to an increased risk of myocardial infarction. Therefore, pharmacological therapies regarding primary or secondary prevention of coronary artery disease need to address sex differences to improve female outcome in the future. This review highlights these differences and specific risk factors in women to consider in pharmacological management of coronary artery disease.