A Sex-Specific View On Coronary Vascular Disease

In coronary artery disease atherosclerosis, i.e., local thickening of the vessel wall, occurs in the cardiac arteries. If the heart (temporarily) does not get enough oxygen due to impaired blood supply, this results in complaints, mainly chest pain or discomfort. We showed that the specific chest pain complaint characteristics help to diagnose coronary artery disease well in both sexes. Interestingly, the value of specific complaints was slightly different for women and men. We also showed that women tend to have less calcified coronaries when suffering from the same degree of coronary artery disease as men. Finally, we focused specifically on women and men with symptoms suggestive for myocardial ischemia with (near) normal coronaries. We demonstrated that most of these patients remain symptomatic in the years following their diagnostic coronary angiography appointment. In addition, they had a higher healthcare consumption than the general population, for both cardiac and psychological complaints. Thus, we concluded that only focusing on obstructed coronaries is not enough to evaluate coronary artery disease in these patients and we should pay attention to these patients after the coronary angiography. In the light of the evidence presented in this thesis, along with other supporting literature, the “one size fits all” approach in which women and men are evaluated similarly no longer seems suitable; a clinician should evaluate his or her patients through sex-colored glasses, supported by a specific guideline for each sex.