Unequivocally, there are differences between women and men in the manifestation and impact of coronary artery disease. We have long known that women tend to develop coronary atherosclerotic disease at a later stage in life than men, which is attributed to estrogen's protective effect on vascular function.1 It remains unclear how much lifestyle patterns contribute to the observed sex differences in the manifestation of coronary artery disease, as cigarette smoking, poor diet, medication adherence, and other factors narrow the gap between women and men.
Armin Arbab‐Zadeh (2026) studied this question. Women develop coronary artery disease later than men, likely due to estrogen's protective effect, but lifestyle factors like smoking and diet reduce this sex difference.