# Premature coronary artery disease in women: sex-specific risk factors, pathogenetic mechanisms and clinical implications

## TL;DR

This paper reviews how premature heart disease in women differs from men, highlighting unique risk factors and the need for tailored treatments.

## Contribution

The paper identifies sex-specific risk factors and genetic influences in premature coronary artery disease in women.

## Key findings

- Women with premature coronary artery disease have unique metabolic and sex-specific risk profiles.
- Genetic factors like 9p21 locus polymorphisms and familial hypercholesterolemia influence disease progression.
- Early detection and sex-tailored interventions are crucial for better outcomes in female patients.

## Abstract

Premature coronary artery disease (PCAD) in women, defined as onset ≤65 years, accounts for 20–30% of CAD cases. The clinical implications, pathogenic processes, and sex-specific risk factors of female PCAD are summarized in this review.

Women have unique patterns in the traditional metabolic risk factors of smoking, diabetes, obesity, and hypertension. Elevated triglyceride-rich lipoproteins and lipoprotein(a) are highly associated with early atherosclerosis. Premature menopause, autoimmune diseases like systemic lupus erythematosus, and pregnancy difficulties like preeclampsia and gestational diabetes are among the special factors that affect women and worsen inflammation and endothelial dysfunction. PCAD progression is also influenced by inflammatory pathways (e.g. NLRP3 inflammasome activation) and genetic predispositions (e.g. 9p21 locus polymorphisms, familial hypercholesterolemia). Diagnostic delays occur because women frequently appear clinically atypically (e.g. fatigue, nausea) and show non-obstructive lesions or spontaneous coronary artery dissection (SCAD). Sex-tailored approaches are needed for management, such as aggressive lipid control, metabolic risk reduction, and psychosocial support.

Female PCAD is a complex condition influenced by a combination of traditional metabolic risk factors, sex-specific factors, and genetic predispositions. Sex-specific biomarkers and multi-omics techniques should be given top priority in future studies in order to improve early detection and tailored treatment.

Female PCAD patients exhibit distinct metabolic and sex-specific risk factor profiles, necessitating tailored management strategies.Genetic predispositions and sex-specific factors, including premature menopause and autoimmune diseases, significantly contribute to the risk and progression of PCAD in women.Early detection and sex-tailored interventions, incorporating advanced biomarkers and multi-omics techniques, are crucial for improving outcomes in female PCAD.

Female PCAD patients exhibit distinct metabolic and sex-specific risk factor profiles, necessitating tailored management strategies.

Genetic predispositions and sex-specific factors, including premature menopause and autoimmune diseases, significantly contribute to the risk and progression of PCAD in women.

Early detection and sex-tailored interventions, incorporating advanced biomarkers and multi-omics techniques, are crucial for improving outcomes in female PCAD.