Related Experiment Video
Updated: Jan 20, 2026
Coronary Artery Disease II: Pathophysiology
Published on: June 19, 2025
Sex-Specific Aspects in the Pathophysiology and Imaging of Coronary Macro- and Microvascular Disease
Floor Groepenhoff1, Sophie H Bots2, Elise L Kessler2
1Laboratory for Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Insights
Sex differences in coronary artery disease (CAD) are significant, with women often experiencing non-obstructive CAD. This review highlights coronary microvascular dysfunction and calls for sex-specific diagnostic approaches to improve patient care.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Research
Background:
- Established sex differences exist in coronary artery disease (CAD), with women more frequently presenting with non-obstructive CAD.
- Coronary microvascular dysfunction is increasingly recognized as a cause of cardiac symptoms, but its sex-specific prevalence remains unclear.
Purpose of the Study:
- To review sex-specific aspects of macro- and microvascular dysfunction in CAD.
- To identify current knowledge gaps regarding sex differences in CAD pathophysiology.
- To evaluate current diagnostic strategies and their suitability for addressing sex-specific variations.
Main Methods:
- Literature review of existing studies on sex differences in CAD.
- Analysis of pathophysiological mechanisms underlying macro- and microvascular dysfunction.
- Assessment of current diagnostic techniques and their sex-specific applicability.
Main Results:
- Women often present with non-obstructive CAD, with microvascular dysfunction being a key factor.
- Evidence regarding the sex-specific prevalence of coronary microvascular dysfunction is inconclusive.
- Current diagnostic methods may not adequately account for sex differences in CAD.
Conclusions:
- Further research is needed to understand sex-specific pathophysiology in CAD.
- Innovation in imaging techniques and perfusion assessment is crucial.
- Clinical practice should consider implementing sex-specific diagnostic approaches for CAD.
Abstract:
Sex differences in coronary artery disease (CAD) are well established, with women presenting with non-obstructive CAD more often than men do. However, recent evidence has identified coronary microvascular dysfunction as the underlying cause for cardiac complaints, yet sex-specific prevalence numbers are inconclusive. This review summarises known sex-specific aspects in the pathophysiology of both macro- and microvascular dysfunction and identifies currently existing knowledge gaps. In addition, this review describes current diagnostic approaches and whether these should take underlying sex differences into account by, for example, using different techniques or cut-off values for women and men. Future research into both innovation of imaging techniques and perfusion-related sex differences is needed to fill evidence gaps and enable the implementation of the available knowledge in daily clinical practice.
More Related Videos
06:18Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm
Published on: September 17, 2021
08:35Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
Related Concept Videos
01:26Coronary Artery Disease II: Pathophysiology
06:18Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm
08:35Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:28Peptic Ulcer Disease II: Pathophysiology
Damaging agents such as Helicobacter pylori, gastric acid, pepsin, and nonsteroidal anti-inflammatory drugs (NSAIDs) can weaken the mucosal defense, allowing hydrogen ions to infiltrate back and harm epithelial cells.
01:30Coronary Artery Disease I: Introduction