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Lookup NU author(s): Professor Vijay KunadianORCiD
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© The European Society of Cardiology 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)Ischaemic heart disease shows important differences between men and women, requiring an understanding of sex and gender dissimilarities to improve outcomes. This Scientific Statement provides an updated review of the current knowledge from risk factors to prognosis. It discusses the unequal impact of certain traditional risk factors between men and women, along with additional factors, such as hormonal changes and treatments (including those for transgender people and cancer), pregnancy-related complications, and autoimmune diseases, which contribute to the sex-specific risk profiles. Moreover, it outlines functional and structural sex differences in the pathophysiology (e.g. coronary atheroma plaques and burden, coronary dissection, vasospasm, and microvascular disease) with women being more prone to microvascular disease and endothelial dysfunction, while paradoxically experiencing less severe myocardial ischaemia at similar levels of coronary stenosis. The document further addresses the evaluation of diagnostic tools, which often have a male-centric bias, resulting in underdiagnosis in women who also tend to receive less guideline-recommended treatment. Additionally, women can have different responses and side effects to various preventive and therapeutic treatments, potentially contributing to the worse prognosis documented in acute coronary syndromes with obstructive coronary artery disease, particularly at a young age. Considering all these sex and gender differences and the low enrolment of women in randomized controlled trials, questions arise regarding the optimal treatment for women. Addressing sex differences requires conducting sex-specific research to close the knowledge gap. Overall, the Scientific Statement highlights all relevant sex- and gender-specific dissimilarities to advance clinical practice and identify directions for future research to improve guideline recommendations for equitable care.
Author(s): Manfrini O, Tousoulis D, Antoniades C, Badimon L, Bugiardini R, Chieffo A, Crea F, De Luca G, Djordjevic-Dikic A, Drenjancevic I, Duncker DJ, Fleming I, Gallinoro E, Kunadian V, Galassi AR, Guzik TJ, Masip J, Merkus D, Milicic D, Poss J, Riou L, Sambola A, Trifunovic-Zamaklar D, Tycinska A, Vavlukis M, Zdravkovic M, Cenko E, Padro T
Publication type: Review
Publication status: Published
Journal: European Heart Journal
Year: 2026
Volume: 47
Issue: 22
Pages: 2727-2749
Print publication date: 07/06/2026
Online publication date: 23/01/2026
Acceptance date: 02/04/2018
ISSN (print): 0195-668X
ISSN (electronic): 1522-9645
Publisher: Oxford University Press
URL: https://doi.org/10.1093/eurheartj/ehaf1059
DOI: 10.1093/eurheartj/ehaf1059
PubMed id: 41571335
