Societal, occupational, and economic considerations for women with (M)INOCA: a narrative review.

Abstract

Cardiovascular disease is one of the leading causes of mortality in women, despite underrepresentation in the medical literature. Women have higher rates of ischemia and no obstructive coronary artery disease (INOCA) and myocardial infarction with no obstructive coronary artery disease (MINOCA) compared to men. The aim of this review is to describe the occupational, economic, and psychosocial factors which disproportionately impact women with (M)INOCA. Relevant databases including MEDLINE, EMBASE, and CINAHL were searched using keywords related to ischemic heart disease, nonobstructive coronary syndromes, (M)INOCA, women's health, questionnaires and surveys, cohort studies, workplace outcomes, and health costs. This narrative review includes key findings from 50 articles that fit the inclusion criteria. Sex-based differences among patients with nonobstructive coronary syndromes are discussed in the context of health care service utilization, working status, and job characteristics. Despite lower mortality rates, nonobstructive coronary syndromes are associated with a large burden of clinical, functional, and economic implications. Women face significant morbidity, productivity losses, and early exit from the workforce. Existing literature focuses on ischemic heart disease as an entity without specific attention to (M)INOCA, and recent health economic studies are lacking. Despite growing recognition of (M)INOCA endotypes and improved diagnostic modalities, its economic and societal impacts remain under-researched, highlighting the need for validated tools to measure work impairment. Collaborative efforts including workplace and employer participation are needed to address work-related outcomes. Researchers and institutions need to consider the interplay of sex-based differences and societal impacts on women. Int J Occup Med Environ Health. 2025;38(3):207-221.