Background: A substantial part of literature has been centered on sex differences
in the clinical aspects of ischemic heart disease (IHD). Many reports have documented differences
in the presentation and risk profile between women and men. Such differences drive
sex-related inequalities in the referral and treatment of IHD. Yet data are insufficient to
clarify the reasons for such disparities. The objective of this review is to analyze the main
gender differences regarding symptoms, diagnosis, and risk stratification of coronary heart
disease in order to identify “gaps” in existing literature that need to be addressed in future
research efforts. Methods: We searched English-language studies on MEDLINE and the
Cochrane Database of Systematic Reviews from the database start dates to January 2016.
Evidence synthesis was based on cohort studies, registry data, and clinical trial data. Results:
Women do not often participate in clinical studies. In a number of articles, authors have
questioned how the "white male” came to be the prototype of the human research subject.
Consequently although many reports continue to describe differential treatment based on patients’ sex, the extent
to which such inequalities are due to true sex differences in pathophysiology or whether they reflects inaccuracy
in risk stratification is unclear. Conclusion: Today, even the best database is incapable in and of itself of
supplying answers to the question of whether women are being treated less compared with men by the medical
Keywords: Women, chest pain, nonobstructive CAD, angina with normal angiography, risk stratification, ischemic heart disease.
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