European cardiologists have documented fundamental differences in how heart disease manifests between sexes, revealing that women develop more microvascular dysfunction and endothelial impairment while paradoxically showing less severe ischemia at equivalent levels of coronary narrowing compared to men. The analysis identifies pregnancy complications, autoimmune conditions, and hormonal treatments as additional female-specific risk factors beyond traditional cardiovascular risks. This sex-based divergence in cardiac pathophysiology helps explain a persistent clinical paradox in cardiology. Despite decades of awareness about gender gaps in heart disease, diagnostic tools remain calibrated primarily for male presentation patterns, leading to systematic underdiagnosis in women who often receive suboptimal guideline-adherent treatment. The microvascular emphasis in female heart disease suggests that current imaging and intervention strategies focused on large vessel stenosis may miss the predominant disease pattern in women. For health-conscious adults, this research underscores the importance of sex-specific risk assessment, particularly for women with autoimmune conditions or pregnancy histories. The findings suggest that women may benefit from diagnostic approaches that evaluate microvascular function rather than relying solely on traditional coronary angiography, potentially revolutionizing preventive cardiology approaches for half the population.