Cardiovascular disease is a major threat to women’s lives and health today. In the ranking of causes of death for women in China, deaths from heart disease have overtaken strokes and tumors as the leading cause of death. The mortality rate of men with coronary heart disease in developed countries has been on a downward trend. However, for many years, the research and prevention of cardiovascular disease in women have been relatively neglected, and the incidence of sudden death in women has been gradually increasing. According to data from the United States, the rate of sudden death among women rose from 38% in 1989 to 47% in 1999, and more women than men died suddenly before arriving at the hospital (52%:42%). Over the past period of time, there has been a great shift in the understanding of the symptoms, pathophysiology, treatment, and clinical prognosis of coronary heart disease in different genders. First, the low incidence of coronary heart disease in women may be due to the high underdiagnosis rate of coronary heart disease in women Previously, it was believed that, except for elderly women, the incidence of coronary heart disease in women of all ages was lower than that of men of the same age group. However, some studies have explained this problem by suggesting that the low incidence of coronary heart disease in women is due to a high under-diagnosis rate of chronic coronary disease or acute coronary syndrome (ACS) in women. Secondly, the positive rate of flat panel exercise test in women is low and the false positive rate is high The positive rate of female patients undergoing flat panel exercise test is lower than that of male patients, and the Coronary Artery Surgery Study Group (CASS) study also found that the false positive rate of exercise test in female patients is 4.5 times higher than that of male patients. According to the latest guidelines for the diagnosis and treatment of myocardial infarction, the number of female patients correctly diagnosed with acute myocardial infarction is 40% less than that of male patients. Fourth, among female patients with evidence of myocardial ischemia, 60% did not have significant stenosis According to the Women’s Ischemic Syndrome Evaluation Study (WISE), among patients with evidence of ischemia detected by chest pain or noninvasive tests, 60% of women did not have a stenosis with a flow-limiting condition after undergoing coronary angiography. Damage to the microvascular structure is more closely associated with coronary artery disease in women. The condition of the retinal arteries was predictive of prognosis in women but not in men. Endothelial dysfunction also plays an important role, and a study enrolling 400 postmenopausal hypertensive women showed that a 10% increase in transmural flow-mediated vasodilation resulted in a 7.3-fold decrease in coronary events. Endothelial dysfunction of the microcoronary arteries has abnormal myocardial perfusion, causing ischemic symptoms, manifested by less severe, widespread but long-lasting chest pain that does not lead to extensive myocardial necrosis, consistent with ischemic symptoms in women. There are also studies confirming that the reserve capacity of coronary arteries in women is lower than that of men. Fifth, the so-called female patients with normal coronary angiography, a significant proportion of the presence of coronary plaque WISE’s subgroup study showed that the so-called female patients with normal coronary angiography, after intravascular ultrasound (IVUS) examination, about 80% of the coronary arteries have plaque lesions, and most of them are multiple lesions. The presence of more coronary plaques found by IVUS may be one of the reasons for the poorer prognosis of some female patients. These plaques have no hemodynamic significance, but may show ischemia in the load test. It is hypothesized that they may be caused by coronary artery spasm, or endothelial dysfunction of the microvessels, resulting in reduced coronary reserve, or may be caused by abnormal myocardial metabolism. Sixth, the low percentage of women with symptomatic, but angiographically confirmed coronary abnormalities may be related to structural damage to the microvasculature and endothelial dysfunction The condition of the retinal arteries is predictive of prognosis in women, but has not been seen to be so predictive in men. Endothelial dysfunction also plays an important role, and a study enrolling 400 postmenopausal hypertensive women showed that a 10% increase in transmural flow-mediated vasodilation resulted in a 7.3-fold decrease in coronary events. Endothelial dysfunction of the microcoronary arteries, resulting in abnormal myocardial perfusion, caused by ischemic symptoms, manifested as chest pain symptoms are not serious, wider in scope but long in duration, will not lead to extensive myocardial necrosis, in line with the ischemic symptoms of women. Seven, imaging as a method of diagnosis of coronary heart disease is not scientific, “women load test false positive rate is high” conclusion needs to be re-examined If the coronary artery imaging as a confirmation of the diagnosis of coronary heart disease evidence, there may be a large proportion of female patients were missed, if the patient’s exercise test is positive may be misjudged as false positive. Eight, there are symptoms of chest pain, but no evidence of ischemia in women, there may be mental reasons A portion of the coronary angiography is normal, but persistent symptoms of chest pain in female patients can not find evidence of ischemia, there may be no myocardial ischemia, this time, chest pain is only the patient’s subjective feeling. Chest pain at this time may be for mental reasons, such as anxiety or panic attacks make the patient feel pain or other sensory abnormalities. Nine, according to the typical symptoms to diagnose coronary heart disease, will cause 65% of women and men coronary heart disease symptomatology there are obvious differences: 1, chronic angina pectoris female patients angina pectoris threshold variation range difference, longer duration, less severe, and the pain range of the distribution of small. 2, acute coronary syndrome Male patients often have chest pain as the main symptom, while female patients complain of more back pain and sweating symptoms, and less diffuse chest pain. Male patients with acute myocardial infarction mostly manifested as crushing chest pain, while female patients complained of shortness of breath, extreme fatigue, with or without typical chest pain, including abdominal, neck and shoulder pain and nausea. 3. The prognosis of acute myocardial infarction is similar regardless of whether the symptoms are typical or not. X. There may be inappropriate over-application of coronary angiography in women Female patients with no significant coronary artery disease detected by coronary angiography have persistent or worsening symptoms, and if these symptoms remain ischemia-induced, the impact on quality of life is very significant, and 4- to 5-year follow-up has revealed a high incidence of adverse cardiovascular events in these patients. In conclusion, the main reason for the poorer prognosis of coronary artery disease in women than in men is that the conclusions of some early studies, including some clinical trials whose study populations often included only men, have been included as evidence in guidelines for the clinical management of cardiovascular disease in both sexes, and there has been a lack of systematic evaluation of the appropriateness of these criteria for women.