Women and coronary artery disease: not just underrepresented and underdiagnosed, but also undertreated!

Despite an increasing awareness of the cardiovascular disease burden in women, they are notably underÂrepresented in cardiovascular clinical trials and under- or mistreated in real-world practice1. Coronary artery disease (CAD) exemplifies the sex disparities in cardiovascular medicine. The proportion of women in trials evaluating coronary interventions usually falls below 30%, despite women experiencing higher rates of adverse cardiac events following both percutaneous coronary intervention (PCI) and bypass surgery23.

In this issue of EuroIntervention, Gaudino and colleagues present a post hoc sex-stratified analysis of the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial, with the aim of assessing the probability of undergoing revascularisation for women and men assigned to the invasive treatment arm, along with exploring sex-related variations in the primary outcome and its individual components4. No sex interaction for the effect of an invasive versus conservative treatment approach on the primary composite endpoint, including cardiovascular death, myocardial infarction (MI) and hospitalisation for cardiac causes, was found. However, women in the invasive arm were significantly less likely to undergo revascularisation compared to men...