Examining the Disproportionate Burden of Microvascular Disease in Women

Microvascular dysfunction (MD) is a systemic condition implicated in a wide range of pathologies, including ischemic heart disease (IHD), stroke, chronic kidney disease (CKD), dementia, pulmonary arterial hypertension (PAH), and pregnancy complications. MD encompasses conditions characterized by small-vessel obstruction, impaired oxygen delivery, defective clearance of cellular waste, and inadequate gas exchange, ultimately leading to tissue damage and organ dysfunction. This review identifies the role of MD in the pathogenesis of a variety of diseases and across organ systems. It highlights the disproportionate burden of MD in women, with a focus on sex-specific risk factors, especially pregnancy. In recent years, there has been increased recognition of the role of MD in the pathogenesis of both cardiac and non-cardiac diseases. Advances in imaging modalities, such as coronary flow reserve assessment and endothelial function testing, have improved the detection of microvascular dysfunction across organ systems. Studies have also highlighted the connection between MD and systemic inflammation, oxidative stress, and hormonal influences, particularly in women. Emerging research suggests that pregnancy-related complications, including preeclampsia and gestational hypertension, may serve as early markers of long-term microvascular dysfunction and cardiovascular disease risk. This review focuses on coronary microvascular dysfunction (CMD) in women, with additional discussion of endothelial and microvascular dysfunction in the renovascular, cerebrovascular, and pulmonary arterial systems. This review describes diagnostic and therapeutic approaches for MD in diverse disease contexts and emphasizes the critical need for research to advance diagnostic tools and therapeutic strategies tailored to the unique needs of women.