Sex differences in coronary artery disease: Pathological observations

•We reviewed sex differences in coronary artery disease (CAD), with emphasis on coronary atherosclerotic disease.•CAD remains the most common cause of death in both men and women.•Most of the risk factors for CAD are similar for men and women, except smoking has a greater detrimental effect in women.•Young women tend to have plaque erosion while older women have plaque rupture.

Cardiovascular disease (CVD) remains the most frequent cause of death in both men and women. Many studies on CVD have included mostly men, and the knowledge about coronary artery disease (CAD) in women has largely been extrapolated from studies primarily focused on men. The influence of various risk factors is different between men and women; untoward effects of smoking of CAD are greater in women than men. Furthermore, the effect of the menopause is important in women, with higher incidence of plaque erosion in young women versus greater incidence of plaque rupture in older women. This review focuses on differences in plaque morphology in men and women presenting with sudden coronary death and acute myocardial infarction.