Basis for sex-specific expression of Takotsubo cardiomyopathy, cardiac syndrome X, and spontaneous coronary artery dissection.

Takotsubo cardiomyopathy, cardiac syndrome X, and spontaneous coronary artery dissection are cardiovascular syndromes with a predilection for women. A complex interplay between neurohormonal factors, genetic influences, anatomic alterations, and other factors together affect cardiovascular function. Specifically, a high, variable, or deficient estrogen state leads to vasomotor instability with propensity toward vasoconstriction and endothelial dysfunction that predispose women to myocardial impairment, microvascular dysfunction, and coronary arterial wall instability. As the predominant sex hormone in women, fluctuating estrogen levels lead to a sex disparity in the expression of these cardiac entities. This review explores the research on sex-based differences of the neurohormonal, genetic, and mechanical factors in the normal cardiovascular system and in the pathophysiology of these 3 conditions. The understanding of their prevalence, pathogenesis, and sex disparity allows improved recognition, management, and support of female patients inflicted with these syndromes.