Sex and gender differences in coronary pathophysiology and ischaemic heart disease

Ischaemic heart disease shows important differences between men and women, requiring an understanding of sex and gender dissimilarities to improve outcomes. This Scientific Statement provides an updated review of the current knowledge from risk factors to prognosis. It discusses the unequal impact of certain traditional risk factors between men and women, along with additional factors, such as hormonal changes and treatments (including those for transgender people and cancer), pregnancy-related complications, and autoimmune diseases, which contribute to the sex-specific risk profiles. Moreover, it outlines functional and structural sex differences in the pathophysiology (e.g. coronary atheroma plaques and burden, coronary dissection, vasospasm, and microvascular disease) with women being more prone to microvascular disease and endothelial dysfunction, while paradoxically experiencing less severe myocardial ischaemia at similar levels of coronary stenosis. The document further addresses the evaluation of diagnostic tools, which often have a male-centric bias, resulting in underdiagnosis in women who also tend to receive less guideline-recommended treatment. Additionally, women can have different responses and side effects to various preventive and therapeutic treatments, potentially contributing to the worse prognosis documented in acute coronary syndromes with obstructive coronary artery disease, particularly at a young age. Considering all these sex and gender differences and the low enrolment of women in randomized controlled trials, questions arise regarding the optimal treatment for women. Addressing sex differences requires conducting sex-specific research to close the knowledge gap. Overall, the Scientific Statement highlights all relevant sex- and gender-specific dissimilarities to advance clinical practice and identify directions for future research to improve guideline recommendations for equitable care.

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Publication Details

Journal
European Heart Journal
Published
2025-12-29
DOI
https://doi.org/10.1093/eurheartj/ehaf1059
Citations
2
Primary Topic
Sex and Gender in Healthcare
Type
article
Field-Weighted Citation Impact
3.76
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article

Sex and gender differences in coronary pathophysiology and ischaemic heart disease

Agnieszka Tycińska, Charalambos Antoniades, Teresa Padró, D. Tousoulis et al.
2 citations
European Heart Journal
Sex and Gender in Healthcare
3.76
article

Sex and gender differences in coronary pathophysiology and ischaemic heart disease

Agnieszka Tycińska, Charalambos Antoniades, Teresa Padró, D. Tousoulis, Guzik Tj, Laurent Riou, Marija Zdravković, Marija Vavlukis, Dirk Jan Duncker, R. Bugiardini, Olivia Manfrini, L G Mendieta Badimon, Antonia Sambola, Kunadian, Josep Masip, Daphne Merkus, Ines Drenjancevic, Davor Milicic, Alfredo R Galassi, Janine Pöss, Emanuele Gallinoro, Filippo Crea, Giuseppe De Luca, Alaide Chieffo, Edina Cenko, Danijela Trifunovic-Zamaklar
article en
2 citations

Abstract

Ischaemic heart disease shows important differences between men and women, requiring an understanding of sex and gender dissimilarities to improve outcomes. This Scientific Statement provides an updated review of the current knowledge from risk factors to prognosis. It discusses the unequal impact of certain traditional risk factors between men and women, along with additional factors, such as hormonal changes and treatments (including those for transgender people and cancer), pregnancy-related complications, and autoimmune diseases, which contribute to the sex-specific risk profiles. Moreover, it outlines functional and structural sex differences in the pathophysiology (e.g. coronary atheroma plaques and burden, coronary dissection, vasospasm, and microvascular disease) with women being more prone to microvascular disease and endothelial dysfunction, while paradoxically experiencing less severe myocardial ischaemia at similar levels of coronary stenosis. The document further addresses the evaluation of diagnostic tools, which often have a male-centric bias, resulting in underdiagnosis in women who also tend to receive less guideline-recommended treatment. Additionally, women can have different responses and side effects to various preventive and therapeutic treatments, potentially contributing to the worse prognosis documented in acute coronary syndromes with obstructive coronary artery disease, particularly at a young age. Considering all these sex and gender differences and the low enrolment of women in randomized controlled trials, questions arise regarding the optimal treatment for women. Addressing sex differences requires conducting sex-specific research to close the knowledge gap. Overall, the Scientific Statement highlights all relevant sex- and gender-specific dissimilarities to advance clinical practice and identify directions for future research to improve guideline recommendations for equitable care.

European Heart Journal
Università Cattolica del Sacro Cuore (IT), Goethe University Frankfurt (DE), Hebron University (PS), Jagiellonian University (PL), Foundation for Biomedical Research (US), University Hospital Centre Zagreb (HR), Medical University of Białystok (PL), Vita-Salute San Raffaele University (IT), Inserm (FR), National and Kapodistrian University of Athens (GR), Instituto de Salud Carlos III (ES), Newcastle upon Tyne Hospitals NHS Foundation Trust (GB), Hospital de Sant Pau (ES), Erasmus MC (NL), University of Oxford (GB), University of Belgrade (RS), Isola (Norway) (NO), Centro de Investigación en Red en Enfermedades Cardiovasculares (ES), Grade Medical (Czechia) (CZ), Istituto Clinico Sant'Ambrogio (IT), Mylan (South Africa) (ZA), Laboratoire de Radiopharmaceutiques Biocliniques (FR), Department of Health (ES), Centro de Investigación Biomédica en Red (ES), Leipzig Heart Institute (DE), CTO Andrea Alesini (IT), Azienda USL di Bologna (IT), Azienda Ospedaliera Sant'Andrea (IT), German Centre for Cardiovascular Research (DE), University of Palermo (AR), Azienda Ospedaliera Universitaria Policlinico "G. Martino" (IT), Centre of Experimental Medicine of the Slovak Academy of Sciences (SK), University of the Sacred Heart (JP), Istituti di Ricovero e Cura a Carattere Scientifico (IT), University Hospital Medical Center Bezanijska kosa (RS), Consorci Sanitari Garraf (ES), The Queen's Medical Research Institute (GB), University of Osijek (HR), Ss. Cyril and Methodius University in Skopje (MK), Ludwig-Maximilians-Universität München (DE), Université Grenoble Alpes (FR), Erasmus University Rotterdam (NL), University of Bologna (IT)
Openalex Percentile: Top 6%
Sex and Gender in Healthcare
3.76
DOIOpen Access PDFOpenAlex
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