Stable angina in young women

Ischaemic heart disease (IHD) is the primary cause of cardiovascular death worldwide. Worryingly, the prevalence of IHD is increasing in younger women, with a 3% increase between 1990 and 2019. Although global IHD death rates have decreased in younger women overall, IHD mortality in younger women is increasing in certain high-income countries. Angina is the primary presenting symptom of suspected IHD and coronary artery disease. The presence of angina in patients with stable coronary artery disease is associated with an increased risk of major cardiovascular events compared with those without angina. Angina in young women is linked to future premature IHD events. There are particular features to consider in younger women presenting with stable angina-anginal symptom characterization may align with older women, but angina may occur cyclically in younger women and a similar pattern may be evident on diagnostic testing. Pathophysiologic mechanisms for angina in some young women may involve effects of ovarian hormones on vascular beds of the cardiovascular system. Traditional IHD risk factors are common to women and men; however, there are certain sex differences in their relevance to IHD risk, as well as influences that female hormones and reproduction have over a life course that affect IHD risk. In this review, we will explore stable angina in young women, consider possible pathophysiological mechanisms involved in their symptom presentation, and present risk factors associated with IHD in women. In addition, potential treatment options will be discussed and attention will be drawn to gaps in the evidence, proposing areas where more research is necessary.