Stable angina and female gender

Cardiovascular disease has been considered a disease of men, while women have been attributed a very low risk of heart disease. However, it is now recognized that heart disease is the first killing disease also in women, and they present often for the evaluation of chest pain symptoms, with stable angina constituting the most common initial presentation of cardiovascular origin. Nonetheless, for the same degree of symptoms as men, women present with less obstructive coronary artery disease. Although clinical evidence for myocardial ischemia in the absence of epicardial obstruction is not a new concept, few studies have assessed its impact on clinical outcomes. In this regard, women represent a very prototypic population subset where presence of ischemia in the absence of coronary artery disease has been associated with worse clinical outcomes. Heart Metab. 2011;50:20–22.