Gynecardiology: Distinct patterns of ischemic heart disease in middle-aged women

•Coronary arterial ageing is importantly different in women than in men.•Women have less obstructive coronary artery disease, but their prognosis is not better.•Over 50% of symptomatic middle-aged women have coronary microvascular dysfunction.•Female-specific risk factors are helpful tools to identify high risk women around menopause.

The past 25 years have revealed that distinct patterns of ischemic heart disease exist in women that are importantly different from the male standard. Premenopausal women have a lower risk factor profile resulting in fewer cardiovascular events at younger age, which reverses at older age. First signs of vascular ageing appear in middle-aged women, with a predominance of functional coronary abnormalities over anatomical obstructions. Over 50% of symptomatic middle-aged women have coronary microvascular dysfunction that is often poorly recognized and treated. This microvascular syndrome has different symptomatic characteristics compared to the classic pattern of angina pectoris related with obstructive coronary disease. Vascular dysfunction is also an important contributor to the occurrence of acute coronary syndromes in relatively young women. Female-specific signs and symptoms related to various stages of life are increasingly helpful tools in identifying women at increased risk. This evolving knowledge in ‘gynecardiology’ is an important challenge for more interaction between gynecologists and cardiologists to further improve accurate prevention in those women at highest need.