The following are key points to remember from this article on sex-specific considerations in the presentation, diagnosis, and management of ischemic heart disease (IHD):

1. Although public awareness of IHD symptoms has increased in women, awareness varies by sociodemographic factors, and lower awareness is associated with younger age. In a national sample of women, only 21% of women reported discussing IHD risk with their doctors.
2. Compared to men, women have higher rates of angina, cardiac hospitalizations, and repeat coronary angiography. The prevalence of IHD and angina varies by race, ethnicity, and age. Morbidity and mortality related to IHD are higher among younger women and Black women after adjustment for potential confounders.
3. Women aged 45-74 years have higher mortality rates after first myocardial infarction than men.
4. Women have higher rates of angina but less obstructive coronary artery disease than men. Women frequently report atypical symptoms, including back pain, epigastric pain, palpitations, and lightheadedness. Atypical symptoms in women are associated with delays in seeking care, diagnosis of IHD, and life-saving treatment.
5. Diabetes and smoking are more potent risk factors for IHD in women than men. Additional risk factors specifically related to women include early menopause, obstetric complications such as pre-eclampsia, and gestational hypertension or diabetes.
6. Coronary artery calcium (CAC) is a strong predictor of subclinical coronary artery disease (CAD) in women, and coronary computed tomography angiography has high diagnostic and prognostic accuracy in women suspected of having CAD.
7. Management of IHD often differs between men and women. Guidelines recommend early invasive strategies for women with non–ST- segment elevation myocardial infarction acute coronary syndrome (NSTEMI-ACS) and high-risk features. Management of risk factors and anti-ischemic medications or revascularization have similar guideline recommendations for men and women.
8. Future efforts related to IHD in women should include research on sex-specific outcomes, characterization of the biological differences, and implementation science around the quality of clinical care. These efforts should include a focus on how social determinants of health impact IHD in women.

Clinical Topics: Acute Coronary Syndromes, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Computed Tomography, Nuclear Imaging, Hypertension, Smoking, Chronic Angina

Keywords: Angina Pectoris, Acute Coronary Syndrome, Back Pain, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease, Diabetes Mellitus, Ethnic Groups, Hypertension, Pregnancy-Induced, Implementation Science, Menopause, Myocardial Infarction, Myocardial Ischemia, Non-ST Elevated Myocardial Infarction, Pre-Eclampsia, Primary Prevention, Risk Factors, Smoking, Social Determinants of Health, Women

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