Coronary heart disease in young women: risk factors, mechanistic phenotypes, and implications for primary care

Coronary heart disease (CHD) in young women remains under-recognized because early risk signals are often dispersed across different clinical settings and symptoms are frequently interpreted as non-cardiac at first contact. This narrative review provides a clinically oriented synthesis that integrates conventional and female-specific cardiovascular risk factors with coronary phenotypes and practical primary-care screening, triage, referral, and longitudinal management. As a narrative review, this study employed a structured but non-systematic literature search of PubMed, CNKI, and the Chinese General Practice journal website for relevant publications available through May 2026, supplemented by manual screening of reference lists. Priority was given to recent cohort studies, systematic reviews, clinical guidelines, expert consensus statements, and representative mechanistic studies.The available literature suggests that hypertension, dysglycemia, smoking, dyslipidemia, family history, and psychosocial stress are not necessarily more severe in young women, but are more likely to be clinically underestimated. Their impact is often amplified when combined with hypertensive disorders of pregnancy, polycystic ovary syndrome, autoimmune disease, antiphospholipid syndrome, or persistent psychosocial burden. Beyond obstructive atherosclerosis, plaque erosion, coronary microvascular dysfunction, vasospasm, myocardial infarction with non-obstructive coronary arteries, and spontaneous coronary artery dissection deserve particular attention. Common primary-prevention risk scores are heavily weighted by age and generally do not fully incorporate female-specific risk-enhancing factors; they should not replace chest-pain risk stratification or mechanism-oriented evaluation in symptomatic patients.Primary care assessment should distinguish among asymptomatic individuals undergoing primary prevention, symptomatic patients presenting with chest pain, and patients with established premature CHD. In the first group, evaluation should focus on basic risk factors, including medical history, blood pressure, body mass index, lipid profile, and glycemic status. In symptomatic patients, electrocardiography and echocardiography should be selected according to the clinical context; high-sensitivity cardiac troponin should be measured when acute coronary syndrome (ACS) or acute myocardial injury is suspected, rather than used as a routine primary-care screening test. Referral for coronary computed tomography angiography or further functional/invasive assessment should be guided by clinical likelihood and the suspected mechanism. Patients with established disease require intensified secondary prevention and long-term follow-up. Recognition of CHD in young women should therefore move beyond the narrow question of visible stenosis and adopt an integrated framework that links conventional risk factors, female-specific exposures, coronary functional phenotypes, and continuity of care.