Sex-related disparities in coronary artery disease in postmenopausal women—a global view and recommendations for the future

Postmenopausal women undergo significant hormonal changes that impact their cardiovascular health. This article explores these hormonal shifts and their implications for cardiovascular risk, alongside physiological changes, clinical implications, and management strategies. Postmenopausal women commonly experience increased incidence of hypertension, dyslipidemia, and glucose intolerance, contrasting with premenopausal profiles and contributing to increased cardiovascular risk. Recent research highlights and future directions are also discussed. This review aims to equip clinicians with the latest insights to develop effective strategies for reduced cardiovascular risk and prevent cardiovascular events and mortality in postmenopausal women. SIGNIFICANCE STATEMENT: Postmenopausal women exhibit a higher prevalence of severe coronary artery disease alongside multiple comorbidities. Nonetheless, there remains a scarcity of data for comparing risk factors, clinical features, and angiographic severity of coronary artery disease between pre- and postmenopausal women and men. Although there are known differences in the development, type, and prognosis of chronic coronary syndrome between both sexes; there are no differences in approach in the guidelines.