Sex differences in coronary atherogenesis: a narrative review

Coronary artery disease (CAD) remains the foremost cause of mortality worldwide, driven primarily by atherogenesis. Recent focus on understanding sex differences in CAD highlights distinct patterns in disease burden, risk factors, and clinical manifestations. This review explores sex differences in CAD, emphasizing the need for tailored diagnostic and management strategies. While men traditionally exhibit higher CAD prevalence and incidence, women present with unique challenges, including delayed diagnosis, atypical symptoms, and lower medication prescription rates. Hormonal, genetic, and lifestyle factors contribute to these differences, with estrogen playing a significant role in mitigating CAD risk in women. Nontraditional risk factors such as chronic inflammation, psychological stress, socioeconomic factors, and reproductive factors further influence CAD development, often overlooked in clinical practice. Addressing these differences requires heightened awareness, improved diagnostic accuracy, and equitable access to care for both sexes. Additionally, increased women’s participation in CAD research is essential to better understand sex-specific mechanisms and optimize treatment outcomes. Tailoring CAD management based on sex-specific insights promises to enhance prognosis and reduce disease incidence in both men and women.