Gender-specific issues in coronary artery disease

The popular perception that Coronary Artery Disease (CAD) is a man’s disease is more of a myth than reality. It is the leading cause of death in adult women. Women with coronary artery disease have a worse outcome as compared with their male counterparts especially the younger ones and should be treated aggressively. CAD in women has certain unique features. Symptoms appear 10 years later in women than in men. The diagnosis is often missed due to the atypical clinical presentations. It has been observed that women commonly have normal coronaries on angiography but that does not mean that it is a benign condition. Inflammation, microvascular disease, endothelial dysfunction, coronary spasm and plaque erosion probably play an important role in the pathogenesis of ischemic heart disease in women. In addition their vessels are smaller with impaired vasodilator responses and lesser collaterals explaining the unfavorable outcome. Non ST elevation syndromes are more common than STEMI in women. Awareness of these peculiarities can help in early diagnosis and timely treatment. There is need to develop newer gender specific diagnostic strategies to detect ischemia in women and to plan appropriate treatment modalities.