Coronary Disease in Women

Are there any differences?

Abstract

Background: In 2019 ischemic heart disease was the leading cause of mortality worldwide accounting for 8.94 million deaths.
Methods: A narrative review of the literature published between 2021 and 2025 was conducted using PubMed. Clinical guidelines, systematic reviews, cohort studies, and clinical trials were included. The search terms were “coronary disease”, “women”, and “myocardial infarction with non obstructive Coronary arteries (MINOCA)”. The information was qualitatively analyzed across four thematic domains: risk factors, pathophysiology, diagnosis and treatment.
Results: Psychosocial, gyneco-obstetric, and autoimmune risk factors predominate in women. Non-obstructive coronary artery disease is the predominant phenotype of ischemic heart disease in this population. Its endotypes—microvascular dysfunction, vasospasm, coronary thrombosis, and coronary dissection—alone or in combination, are the main causes of clinical syndromes related to myocardial infarction with angiographically normal coronary arteries. The diagnosis of ischemic heart disease focuses on confirming obstructive atherosclerotic coronary disease (>50% stenosis) through initial functional or anatomical tests; when no obstruction is documented, advanced invasive and noninvasive imaging techniques should be employed. A patent artery on angiography does not rule out atherosclerosis; therefore, other imaging modalities (e.g., intravascular ultrasound) and functional tests are valuable tools for guiding individualized therapy.
Conclusions: Non-obstructive coronary artery disease is the predominant phenotype of ischemic heart disease in women. Its evaluation should be directed toward recognizing the underlying endotypes to guide personalized treatment.