The article discusses the gender differences in coronary heart disease (CHD), highlighting that CHD develops 7 to 10 years later in women than in men and remains the leading cause of death in women over 65. The risk of heart disease in women is often underestimated due to the misconception that females are less susceptible to cardiovascular disease. This under-recognition leads to less aggressive treatment strategies and a lower representation of women in clinical trials. The review emphasizes the need for greater awareness among women about their cardiovascular risk factors and self-awareness to improve prevention and treatment. Key points include: - **Epidemiology and Menopause**: Endogenous oestrogens delay the onset of atherosclerotic disease in women, but early menopause increases the risk of CHD. - **Risk Factors**: Women have a higher risk of CHD at younger ages, with smoking being more detrimental to women's health. Postmenopausal women experience changes in body composition and increased risk factors for diabetes and hypertension. - **Clinical Presentation**: Women often present with atypical symptoms of chest pain, making diagnosis and treatment more challenging. Noninvasive tests like ECG and stress imaging have lower accuracy in women. - **Acute Coronary Syndromes (ACS)**: Women with ACS tend to have more comorbidities and higher mortality rates. Treatment strategies should be tailored to gender differences, with conservative approaches being more appropriate for low-risk women. - **Chest Pain with 'Normal' Coronary Angiograms**: Women often present with ACS despite normal angiograms, suggesting the presence of microvascular dysfunction, which requires aggressive management. The article concludes that improved awareness and targeted interventions are necessary to address the under-recognition and undertreatment of CHD in women.The article discusses the gender differences in coronary heart disease (CHD), highlighting that CHD develops 7 to 10 years later in women than in men and remains the leading cause of death in women over 65. The risk of heart disease in women is often underestimated due to the misconception that females are less susceptible to cardiovascular disease. This under-recognition leads to less aggressive treatment strategies and a lower representation of women in clinical trials. The review emphasizes the need for greater awareness among women about their cardiovascular risk factors and self-awareness to improve prevention and treatment. Key points include: - **Epidemiology and Menopause**: Endogenous oestrogens delay the onset of atherosclerotic disease in women, but early menopause increases the risk of CHD. - **Risk Factors**: Women have a higher risk of CHD at younger ages, with smoking being more detrimental to women's health. Postmenopausal women experience changes in body composition and increased risk factors for diabetes and hypertension. - **Clinical Presentation**: Women often present with atypical symptoms of chest pain, making diagnosis and treatment more challenging. Noninvasive tests like ECG and stress imaging have lower accuracy in women. - **Acute Coronary Syndromes (ACS)**: Women with ACS tend to have more comorbidities and higher mortality rates. Treatment strategies should be tailored to gender differences, with conservative approaches being more appropriate for low-risk women. - **Chest Pain with 'Normal' Coronary Angiograms**: Women often present with ACS despite normal angiograms, suggesting the presence of microvascular dysfunction, which requires aggressive management. The article concludes that improved awareness and targeted interventions are necessary to address the under-recognition and undertreatment of CHD in women.