Angina in women.

Angina pectoris, the pain of myocardial ischemia, is the major initial and subsequent presentation of coronary disease in women. Angina in women is associated with more adverse morbidity, mortality, and quality-of-life outcomes than for men, despite women having less obstructive coronary artery disease and better left ventricular function. Women with chest pain and myocardial ischemia, in the absence of significant obstructive disease of the coronary arteries, have prominent morbidity and mortality outcomes; the postulated mechanism is microvascular disease. Women also have more non-chest pain manifestations of myocardial ischemia than men. These variables must be incorporated in assessments of optimal diagnostic and therapeutic strategies for myocardial ischemia in women.