A Woman's Heart: The Microvascular Disease Dilemma

Coronary microvascular and vasomotor dysfunction (CMVD) is not a novel entity, and it disproportionally affects more women than men presenting with cardiac symptoms in the setting of nonobstructive coronary artery disease. Recent advances in the development and validation of diagnostic tools have brought CMVD into sharper focus, driving renewed interest and momentum in cardiovascular research within this field. In this review, we summarize current understanding of CMVD pathophysiology, discuss available diagnostic modalities and their limitations, and review contemporary management strategies, with particular emphasis on the multidisciplinary contributions of allied health professionals and the role of patient-support groups. Importantly, we emphasize the recognition of sex-specific differences in the prevalence, underlying mechanisms, symptom burden, and prognosis of CMVD as a clinical and research priority, as it provides the biological and clinical rationale for sex-specific diagnostic strategies and more personalized management and therapeutic approaches. Finally, we also discuss our perspective on how different organizations can help promote the awareness and research to enhance our ability to diagnose and treat this condition in future.