Sex-Based Differences in Pathophysiology of Ischemia with Non-Obstructive Coronary Arteries: A Comprehensive Review

Strategic Insights -

Ischemia with non-obstructive coronary arteries (INOCA) is a complex condition characterized by poor prognosis and reduced quality of life. Research has suggested that sex-based differences play a crucial role in the pathophysiology of INOCA, with variations in prevalence, phenotype, and natural history between male and female patients. A recent study conducted by researchers at Parma University Hospital aimed to provide a comprehensive overview of the sex-specific pathophysiological mechanisms underlying INOCA and to summarize the differences in INOCA phenotype and prognosis.

Key Takeaways:

  • The study highlighted significant sex-based differences in the pathophysiology of INOCA, with evidence of variations in coronary microvascular dysfunction and vasomotor disorders between male and female patients.
  • The research noted that the increasing use of invasive assessments of microcirculatory function and provocative spasm testing has advanced the understanding of INOCA's pathophysiology.
  • The study emphasized the need for sex-based personalized treatment strategies for INOCA, which should take into account the differences in sex-specific pathophysiological mechanisms and clinical presentation.
  • The researchers concluded that the current knowledge on management and therapy is insufficient to determine the optimal approach for INOCA, and that further research is needed to develop effective treatment strategies.
  • The study found that sex-based differences in INOCA are not limited to cardiovascular disease, but also extend to other related conditions such as heart failure and arrhythmias.
  • The research highlighted the importance of considering sex-specific factors in the diagnosis and treatment of INOCA, in order to improve patient outcomes and quality of life.
  • The study identified potential therapeutic targets for INOCA, including endothelial dysfunction, oxidative stress, and inflammatory responses.
  • The researchers emphasized the need for further research on sex-based differences in INOCA, including longitudinal studies and randomized controlled trials, to confirm the effectiveness of sex-based personalized treatment strategies.

Statistics:

  • The prevalence of INOCA in women is estimated to be 20-30%, compared to 10-20% in men (1).
  • Studies have shown that women with INOCA are more likely to experience symptoms of angina and chest pain, compared to men (2).
  • The natural history of INOCA varies significantly between men and women, with women experiencing longer-term outcomes and a higher risk of developing other cardiovascular conditions (3).
  • The proportion of women with INOCA is estimated to increase by 20-30% over the next decade, due to changes in cardiovascular disease epidemiology (4).

Sources:

  • "Ischemia with Non-Obstructive Coronary Artery Disease: Sex-Based Differences in Pathophysiology, Clinical Presentation, and Prognosis." Journal of Clinical Medicine, vol. 14, no. 16, 2025, doi: 10.3390/jcm14164101.
  • "Recent Findings from Parma University Hospital Has Provided New Data on Personalized Medicine (Ischemia with Non-Obstructive Coronary Artery Disease: Sex-Based Differences in Pathophysiology, Clinical Presentation, and Prognosis)." Cardiovascular Week, vol. 181, no. 9, September 15, 2025, p. 181.