Coronary Artery Disease in Female Athletes

This case series highlights the unique presentation and diagnostic challenges of coronary artery disease (CAD) in female athletes. Despite generally lower prevalence, women may experience atypical symptoms and delays in diagnosis, often due to the under-recognition of risk and subtle clinical signs. We describe 3 cases of CAD among women during different stages of life: a postmenopausal long-distance runner with complex coronary anatomy, a postmenopausal triathlete with severe left anterior descending artery stenosis, and a young climber in her reproductive years with acute coronary syndrome. These cases underscore the importance of thorough evaluation, including advanced imaging such as coronary computed tomography angiography, and reveal how gender-specific factors, menopause, and training patterns influence CAD detection and outcomes. There is a need for tailored, athlete-specific diagnostic algorithms to ensure early identification and management of CAD in women, ultimately reducing gender disparities in cardiovascular care and improving prognosis in female athletes.