The Ewha Medical Journal
Ewha Womans University School of Medicine

Sex differences in coronary atherogenesis: a narrative review

Hack-Lyoung Kiim*
1Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National Univerisity College of Medicine, Seoul 07061, Korea.
*Corresponding Author: Hack-Lyoung Kiim, Phone: 01077442876. E-mail:

© Copyright 2024 Ewha Womans University School of Medicine. This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: Feb 26, 2024; Revised: Apr 15, 2024; Accepted: Apr 18, 2024

Published Online: Apr 30, 2024


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.

Keywords: Atherogenesis; Coronary artery disease; Sex difference