Differences in non-obstructive atherosclerotic plaques between men and women, a narrative review article

Ischemic heart disease (IHD) is the main cause of mortality in the world. Presence of significant stenosis in coronary arteries is the cornerstone of diagnosis and treatment in symptomatic patients. Although stenotic coronary arteries due to atherosclerotic lesion is the most cause of IHD, there is no important stenotic lesion(s) in major proportion of symptomatic patients (especially female patients). The aim of this article is to review recent literatures about the important differences of men and women in clinical manifestation, risk factors, diagnosis, and prognosis of microvascular coronary disease.

The search was conducted for articles published between 2011 and 2021 in PubMed using the following key words: ''Women'' AND ['' Coronary microvascular disease'']. Data were collected by reviewing the texts.

Well defined risk factors of IHD may have important role in development of microvascular coronary disease, but exact mechanism of it is unclear. Disorders in coronary microvascular structure or function is common in women and may happen in the absence of stenotic epicardial coronary arteries, while is associated with cardiac events and mortality.

There is limited data about non obstructive coronary disease. The prognosis of IHD is worse in women compared to men; it could be explained by identification of more cardiac risk factors in women and pay attention to different effects of risk factors between men and women, and presence of unique risk factors for women.