Cardiovascular disease (CVD) develops 7 to 10 years later in women than in men and remains the leading cause of death in women over 65. Women are often underestimated in their risk due to the misconception that they are protected from CVD. This leads to under-recognition of heart disease, differences in clinical presentation, and less aggressive treatment strategies, as well as fewer women in clinical trials. Self-awareness and identification of cardiovascular risk factors are crucial for better prevention. This review summarizes key issues in the diagnosis and treatment of coronary heart disease (CHD) in women. Epidemiologically, CVD in women is influenced by menopause, with a lower CHD event rate before menopause, primarily due to smoking. Early menopause is associated with reduced life expectancy. Hormonal changes during menopause affect metabolic factors, such as lipids and inflammation, and increase the risk of atherosclerosis. Women with early menopause have a higher risk of coronary artery disease. Gender differences in CHD risk factors are significant. Menopause transition worsens the CHD risk profile. Women with CHD are generally older and have more cardiovascular risk factors. Smoking is more harmful in women, increasing the risk of myocardial infarction. Body weight changes post-menopause and increases the risk of metabolic syndrome. Women with diabetes have higher cardiovascular complications. Hypertension is more prevalent in women after menopause, with increased risks of left ventricular hypertrophy and strokes. Blood pressure rises more steeply in women compared to men. Lipid profiles change post-menopause, with increased cholesterol and LDL levels. Statin therapy is effective in women for secondary prevention but controversial in primary prevention. Women have lower absolute risk in certain age groups, but statins still offer benefits in primary prevention. Women with polycystic ovary syndrome (PCOS) have higher cardiovascular risks. Hypertensive disorders during pregnancy increase future CHD risk. Clinical presentation of CHD in women is less reliable, with more common chest pain syndromes not related to atherosclerosis. Non-invasive testing is less sensitive in women. Stress echocardiography and imaging techniques like PET and CMR are useful for detecting microvascular dysfunction. Women with ACS often have 'normal' coronary angiograms, indicating microvascular dysfunction. Acute coronary syndromes (ACS) in women present differently, with more vaso-vegetative symptoms. Women have higher mortality risks, influenced by gender bias in treatment and vascular differences. Women with ACS have less extensive obstructive disease but higher rates of non-obstructive disease. Early invasive strategies are less effective in women compared to men. Chest pain with 'normal' coronary angiograms is common in women, indicating microvascular dysfunction. Women with such conditions have worse outcomes and require aggressive treatment. In conclusion, CVD is the leading cause of death in women, often under-recognized and undertreated. Healthcare professionals must beCardiovascular disease (CVD) develops 7 to 10 years later in women than in men and remains the leading cause of death in women over 65. Women are often underestimated in their risk due to the misconception that they are protected from CVD. This leads to under-recognition of heart disease, differences in clinical presentation, and less aggressive treatment strategies, as well as fewer women in clinical trials. Self-awareness and identification of cardiovascular risk factors are crucial for better prevention. This review summarizes key issues in the diagnosis and treatment of coronary heart disease (CHD) in women. Epidemiologically, CVD in women is influenced by menopause, with a lower CHD event rate before menopause, primarily due to smoking. Early menopause is associated with reduced life expectancy. Hormonal changes during menopause affect metabolic factors, such as lipids and inflammation, and increase the risk of atherosclerosis. Women with early menopause have a higher risk of coronary artery disease. Gender differences in CHD risk factors are significant. Menopause transition worsens the CHD risk profile. Women with CHD are generally older and have more cardiovascular risk factors. Smoking is more harmful in women, increasing the risk of myocardial infarction. Body weight changes post-menopause and increases the risk of metabolic syndrome. Women with diabetes have higher cardiovascular complications. Hypertension is more prevalent in women after menopause, with increased risks of left ventricular hypertrophy and strokes. Blood pressure rises more steeply in women compared to men. Lipid profiles change post-menopause, with increased cholesterol and LDL levels. Statin therapy is effective in women for secondary prevention but controversial in primary prevention. Women have lower absolute risk in certain age groups, but statins still offer benefits in primary prevention. Women with polycystic ovary syndrome (PCOS) have higher cardiovascular risks. Hypertensive disorders during pregnancy increase future CHD risk. Clinical presentation of CHD in women is less reliable, with more common chest pain syndromes not related to atherosclerosis. Non-invasive testing is less sensitive in women. Stress echocardiography and imaging techniques like PET and CMR are useful for detecting microvascular dysfunction. Women with ACS often have 'normal' coronary angiograms, indicating microvascular dysfunction. Acute coronary syndromes (ACS) in women present differently, with more vaso-vegetative symptoms. Women have higher mortality risks, influenced by gender bias in treatment and vascular differences. Women with ACS have less extensive obstructive disease but higher rates of non-obstructive disease. Early invasive strategies are less effective in women compared to men. Chest pain with 'normal' coronary angiograms is common in women, indicating microvascular dysfunction. Women with such conditions have worse outcomes and require aggressive treatment. In conclusion, CVD is the leading cause of death in women, often under-recognized and undertreated. Healthcare professionals must be