Sex differences in coronary atherogenesis: a narrative review

Coronary artery disease (CAD) remains the leading cause of mortality worldwide, driven primarily by atherogenesis. Recent efforts to understand sex differences in CAD have revealed distinct patterns in disease burden, risk factors, and clinical presentations. This review examines these sex differences in CAD, underscoring the importance of customized diagnostic and management strategies. Although men typically have higher rates of CAD prevalence and incidence, women face unique challenges, such as delayed diagnosis, atypical symptoms, and lower rates of medication prescription. Hormonal, genetic, and lifestyle factors all play a role in these disparities, with estrogen notably reducing CAD risk in women. Nontraditional risk factors, including chronic inflammation, psychological stress, socioeconomic status, and reproductive history, also contribute to CAD development and are often neglected in clinical settings. Addressing these differences requires increased awareness, more accurate diagnosis, and equitable healthcare access for both sexes. Furthermore, greater inclusion of women in CAD research is essential to better understand sex-specific mechanisms and optimize treatment outcomes. Personalizing CAD management based on sex-specific knowledge has the potential to improve prognosis and decrease disease incidence for both men and women.