REVIEW PAPER
Societal, occupational, and economic considerations for women with (M)INOCA: a narrative review
More details
Hide details
1
University of British Columbia, Vancouver, British Columbia, Canada
(Department of Medicine)
2
Vancouver Coastal Health, Vancouver, British Columbia, Canada
3
BC Women’s Hospital, Vancouver, British Columbia, Canada
Online publication date: 2025-06-13
Corresponding author
Tara L. Sedlak
Vancouver General Hospital, Division of Cardiology, 9th Floor, 2775 Laurel St., Vancouver, British Columbia V5Z 1M9, Canada
HIGHLIGHTS
- Nonobstructive coronary disease, i.e., myocardial infarction with no obstructive coronary artery disease (M)INOCA,
- disproportionately affects women.
- Women with (M)INOCA suffer from increased emotional and physical stress.
- Greater morbidity and symptom burden impairs participation in the workforce.
- Effective tools for evaluating productivity losses in this population are lacking.
KEYWORDS
TOPICS
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)