Ischemic heart disease in women: an appropriate time to discriminate.

Although cardiovascular mortality for men has been declining, the number of women dying from cardiovascular disease has slightly increased. Differences between women and men have been identified throughout the entire spectrum of ischemic heart disease, from risk factors to presentation and from diagnosis to treatment and outcomes. In the setting of an acute coronary syndrome or acute myocardial infarction, women are significantly more likely than men to report multiple non-chest pain symptoms, including dyspnea, nausea/vomiting, abdominal pain, back pain, neck pain, and jaw pain. Investigations into the pathophysiology of ischemic heart disease in women have broken away from the traditional thinking that coronary artery disease simply equals epicardial stenosis. In women, the new paradigm of coronary artery disease also focuses on diffuse atherosclerosis, endothelial dysfunction, and microvascular disease. Further research focusing on sex differences in cardiovascular disease is needed, but enough is currently known to offer a sex-based approach, which may ultimately lead to improved outcomes.