RESUMO
Ischemic heart disease (IHD) is the leading cause of death in women as in men. Several disease mechanisms, however, differ between genders. Women with IHD more frequently than men have normal or non-obstructive epicardial arteries, plaque erosion, spontaneous coronary dissection, microvascular dysfunction, stress cardiomyopathy, and heart rupture after acute infarction. Compared to men, IHD presents 7-10 years later with a heavier burden of cardiovascular risk factors, even after correction for age. The typical woman with IHD is old and frail, with comorbidities such as renal failure. Another vulnerable group comprises those with acute coronary syndromes before the age of 60 in whom hospital mortality is reported to be almost twice that of age-matched men. Such vulnerabilities in women, in apparent contrast with the delayed onset and lesser extent of epicardial atherosclerosis, may be attributable to biases in prevention, presentation, diagnosis and treatment of female IHD, but also to gender-related differences in disease mechanisms.