Stable Ischaemic Heart Disease, Including Obstructive CAD, INOCA and Coronary Vasomotor Disorders

Ischaemic heart disease (IHD) is the leading cause of death in women worldwide. The presentation of chronic coronary syndrome (CCS) differs in men and women, which may be a function of different pathophysiological mechanisms. Classically, IHD was recognised as a consequence of decreased coronary perfusion secondary to atherosclerotic lesions, however this rhetoric has since been reconsidered as myocardial microcirculation may play a much wider role in the pathophysiology of angina than previously thought. Women are more likely to be diagnosed with angina secondary to non-obstructive coronary arteries and are at greater risk of coronary microvascular dysfunction. Unfortunately, most clinical trials have a male preponderance, which makes it challenging to extrapolate specific therapies for IHD in women. Most guidelines focus on such trials and thus there remain important knowledge gaps for the future of management of stable IHD in women.