Gender Disparities in Ischemic Heart Disease Management: Underdiagnosis in Women and Differences in Treatment

Ischemic heart disease (IHD) remains the leading cause of death globally, with mounting evidence of gender disparities in its diagnosis, management, and outcomes. Women are frequently underdiagnosed and undertreated despite having similar or greater cardiovascular risk compared to men. These disparities contribute to delayed care, suboptimal treatment, and poorer short- and long-term outcomes in women. A narrative review was conducted using peer-reviewed literature published between 2015 and 2025. The search focused on gender differences in IHD presentation, diagnosis, pharmacologic and interventional treatment, and specific conditions such as myocardial infarction with non-obstructive coronary arteries (MINOCA) and spontaneous coronary artery dissection (SCAD). Articles providing quantitative data, clinical observations, or expert consensus on gender disparities in IHD were prioritized. Our results indicate that women are less likely to receive diagnostic imaging, percutaneous coronary intervention, and statin therapy, even when presenting with comparable clinical indicators. Atypical symptom presentations and a higher prevalence of non-obstructive disease, including MINOCA and SCAD, contribute to underdiagnosis. Women with ST-elevation myocardial infarction also have higher rates of bleeding complications and 30-day mortality, emphasizing the need for tailored therapeutic protocols. Cardiac rehabilitation participation is significantly lower among women due to systemic barriers such as referral bias, socioeconomic factors, and program design not tailored to women's needs. Clinical trials continue to underrepresent women, limiting sex-specific evidence to guide care. Persistent gender disparities in IHD highlight the urgent need for sex-specific diagnostic pathways, treatment protocols, and greater representation of women in cardiovascular research. Enhancing clinician awareness, modifying existing guidelines, and restructuring clinical trials to include sex-disaggregated analysis are essential. These efforts are critical to improving cardiovascular outcomes and achieving equity in IHD care for women.