Gender differences: it’s time for a？rational approach

The present issue of the Netherlands Heart Journal focusses on gender differences in coronary artery disease. The development of coronary artery disease is markedly different between men and women [1]. In general, in men, with risk factors, coronary artery disease develops gradually over decades leading to symptoms, typically, at the age of 60. In women, the onset of coronary atherosclerosis starts later and accelerates after menopause. Rare complications such as spontaneous coronary dissections and Takotsubo syndrome occur much more frequently in women, as outlined in this issue [2]. However, vasospastic angina, either caused by epicardial or microvascular vasospasm, is a more frequent phenomenon that affects women more often than men [3]