Chronic ischemic heart disease
² ARCA Toscana, Pisa, Italy
³ Unita Operativa di Cardiologia, Ospedale S. Maria, Terni (TR), Italy
⁴ Medico di Medicina Generale, ASL Pescara; SIMG, Societa Italiana dei Medici di Medicina Generale e Cure Primarie Responsabile Macroarea Cronicita
Abstract
The present paper provides an analysis of chronic coronary syndromes, emphasizing the influence of sex and gender on epidemiology, clinical presentation, pathophysiology, and prognosis. Chronic coronary syndromes display significant differences between men and women: men tend to develop coronary disease at a younger age, often associated with traditional risk factors such as smoking and hypertension, while women typically manifest disease later, especially after menopause, due to loss of estrogenic protection. Non-traditional risk factors, including psychosocial stress, depression, and chronic inflammation, have a greater impact on women’s cardiovascular health, underscoring the need for gender-sensitive prevention strategies. Clinical presentation is different in men and women: women frequently report atypical symptoms such as nausea, fatigue, and dyspnea, which can lead to delayed or incorrect diagnosis, as standard diagnostic parameters are often validated on male populations. From a pathophysiological perspective, men are more likely to present with obstructive coronary disease, whereas women more commonly exhibit non-obstructive forms and microvascular dysfunction, particularly aggravated by hormonal changes after menopause. Risk stratification tools, such as the Framingham Risk Score and ASCVD calculator, are often inadequate for women, who may experience worse outcomes despite lower risk scores, a phenomenon known as the gender paradox. The Authors advocate for the development of sex- and gender-specific predictive models and highlight the importance of integrating hormonal, clinical, and psychosocial factors into risk assessment.
Key words: Women; Chronic Coronary Syndromes; Sex and Gender Differences; Clinical Presentation; Microvascular Dysfunction; Risk Stratification.
