{
  "abstract": "Introduction Ischaemia with non-obstructive coronary arteries (INOCA) describes the clinical syndrome where there is evidence of myocardial ischaemia in the absence of flow-limiting coronary artery stenosis. INOCA has been associated with adverse cardiovascular outcomes and reduced quality of life and disproportionately affects women. Yet sex-specific differences in clinical characteristics, management and coronary physiology remain poorly defined. We performed a systematic review and meta-analysis to investigate differences in characteristics of females and males with INOCA.Methods A systematic search of Medline, Google Scholar and the Cochrane Library was conducted in May 2023. Studies including stable angina or with non-obstructive coronary arteries and reporting sex-stratified data were included. Acute coronary syndrome populations were excluded. Data including demographics, cardiovascular risk factors, comorbidities, medication use, symptoms, quality of life measures and coronary physiology parameters where available were extracted. Pooled standardised differences between females and males were calculated in R Studio. Study quality was assessed using the Newcastle–Ottawa Quality Assessment Scale and funnel plots were used to assess publication bias.Results Twelve studies comprising 13 independent cohorts were included with a total of 9,546 patients (57.7% female). Females were older than males (P<0.001) and were significantly less likely to have ever smoked (P<0.001). Females were less likely to be receiving antiplatelet therapy compared with males (p=0.03; data available in five studies, n=1681, 64.1% female) and there was a non-statistically significant trend towards lower statin use (data available in six studies, n=2367, 64% female). Similar rates of typical and atypical anginal symptoms were experienced by both sexes, though there was a trend toward more frequently experienced dyspnoea in females (P=0.057). Coronary physiology assessment (available in six studies, n=3180, 64.7% female) demonstrated trends towards a higher prevalence of microvascular spasm (P=0.067) and lower coronary flow reserve (P=0.091) in females. Across Seattle Angina Questionnaire domains (available in three studies, n=1509, 61.9% female), there were non-statistically significant trends towards greater physical limitation and lower treatment satisfaction in females.Conclusions Women with INOCA appear to demonstrate distinct clinical characteristics, experience differences in medical therapy, and trends towards greater microvascular dysfunction and impaired quality of life compared with men. These findings suggest that INOCA in women may represent a distinct clinical phenotype that is under-recognised and potentially under-treated. Improved awareness of sex-specific differences, alongside sex-specific diagnostic pathways and management strategies, is essential to optimise care and outcomes for this patient population.",
  "authors": [
    {
      "affiliations": [
        "Luton and Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Luton, United Kingdom"
      ],
      "name": "Margaret Siu"
    },
    {
      "affiliations": [
        "Barts and the London Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom",
        "Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom"
      ],
      "name": "Andrew J Sullivan"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, United Kingdom"
      ],
      "name": "Kayla Chiew"
    },
    {
      "affiliations": [
        "Barts Cardiovascular Clinical Trials Unit, Queen Mary University of London, London, United Kingdom"
      ],
      "name": "Annastazia Learoyd"
    },
    {
      "affiliations": [
        "Department of Biomedical Sciences, Humanitas University, Milan, Italy",
        "IRCCS Humanitas Research Hospital, Milan, Italy"
      ],
      "name": "Mauro Gitto"
    },
    {
      "affiliations": [
        "Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands"
      ],
      "name": "Paula Mommersteeg"
    },
    {
      "affiliations": [
        "Barts and the London Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom",
        "Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom"
      ],
      "name": "Krishnaraj Rathod"
    },
    {
      "affiliations": [
        "Barts and the London Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom"
      ],
      "name": "Amrita Ahluwalia"
    }
  ],
  "title": "200 Sex differences in ischaemia with non-obstructive coronary arteries: a systematic review and meta-analysis",
  "uid": "4345ad14-fb61-5355-82c5-5aebf0333f45"
}