Table 4. Overview of the influence of the intersection of sex, ethnicity, and age on the development of CAD  .

CAD: Coronary artery disease, SBP: Systolic blood pressure, CHD: Coronary heart disease, STEMI: ST-elevation myocardial infarction, CABG: Coronary artery bypass grafting, NSTEMI: Non-ST-elevation myocardial infarction, PCI: Percutaneous coronary intervention, IHD: Ischemic heart disease, MI: Myocardial infarction, AMI: Acute myocardial infarction, LAD: Left anterior descending, TVD: Triple-vessel disease, TVR: Target vessel revascularization, ST: Stent thrombosis, NHW: Non-Hispanic White

Identification and Year of Publication	Outcome Measures	Key Findings	Limitations
Pencina et al. (2019) [4]	The focus of this cohort is the comparison of the connection between risk determinants that can be changed, particularly diabetes mellitus, systolic blood pressure (SBP), smoking, lipids, and CHD phenomena, and how the measurements change when adjusted by age and risk factors.	Most of the prognostic data used in the 10-year CHD risk models is predominantly non-modifiable determinants like race, sex, and age.	Some of the information dates back to the 1990s, so it may not represent the changes that happened more recently.
Khera et al. (2015) [61]	The observational study measured temporal patterns and sex-based discrepancies in revascularization strategies and death rates in hospitals for patients with STEMI under 65 years of age.	STEMI is a common CAD presentation in young adults. In contrast with males, it is more improbable for females to receive treatment, such as percutaneous coronary intervention, and they have an elevated death rate in the hospital.	The data may not be representative of more recent trends in management and results for patients under the age of 60 diagnosed with STEMI.
Efird et al. (2015) [62]	The observational study measured the relation between sex and race and the number of vessels affected after a coronary artery bypass grafting procedure. It also measured the end results after the surgery.	Black women CABG patients exhibited a pronounced number of affected vessels in contrast to White women CABG patients. This pattern was not seen among Black and White men. In comparison to other races and sexes, Black females remained for a prolonged period of time in the critical care unit.	This analysis disregarded lesion complexity based on pre-treatment angiographic parameters. The race was self-reported, while social factors information was not collected and taken into account.
Tertulien et al. (2022) [63]	The observational study evaluated individuals presenting with non-ST-elevation myocardial infarction (NSTEMI) and measured the rates of coronary angiography and percutaneous coronary intervention (PCI) by race, ethnicity, and income categories.	Black individuals and Hispanics exhibited lower chances of undergoing PCI and coronary angiography compared to White patients. The lower annual household income also impacted the chances of Asian, Black, and Hispanic individuals to undergo the above procedures.	The data represents only private insured patients, so it cannot be generalized to uninsured patients. Demographic and administrative data are subject to misclassification.
Nowbar et al. (2019) [64]	The observational study measured age-standardized mortality rates and crude death rates for ischemic heart disease (IHD) and other noncommunicable diseases in different countries in which income varied. Sex-based differences were also examined.	The rate of IHD mortality is gradually decreasing in all countries, regardless of population income. The death rate rose as patients got older, and males had a greater mortality rate than females in all the countries selected for this study.	Insufficient information regarding income for some developing countries, particularly Africa, and countries with higher incomes, such as China, is inaccessible. Not all the risk factors were encompassed; information for hypercholesterolemia was left out of this study.
Canto et al. (2012) [65]	The retrospective study analyzed the proportion of individuals hospitalized with myocardial infarction who did not manifest chest pain, the in-hospital death rate, and the relation of age and mortality rate with those lacking chest pain, identifying differences by age, sex, and symptom presentation.	Chest pain was more pronounced in younger (below 65) patients. The mortality rate for patients older than 65 years old was considerably higher than for younger patients. Females did not have chest pain as often as males, and compared to males of the same age, the death rate was more elevated in females.	Patients from NMRI and hospitals that participated might not represent the entire population diagnosed with MI and hospitals in the USA. The definition of MI at the time the study was conducted (< 2007) is different from the actual definition.
George et al. (2021) [66]	The cross-sectional study tried to identify discrepancies in risk determinants, clinical presentation, and coronary angiography among patients of both sexes with MI.	It is more probable for females to show less typical signs and still less probable for them not to go through coronary angiography in contrast to men.	Generalization of discoveries to other populations might be restricted because the research was made in only one tertiary care center in South India. The causality could not be established.
Bajaj et al. (2016) [67]	The observational study focused on assessing the sex discrepancies in clinical manifestation, risk factors, and angiographic disease in patients with acute MI from North India.	Females demonstrate signs of cardiovascular disease when they are older and have an elevated incidence of diabetes and hypertension. While males have a greater prevalence of dyslipidemia, smoking, and BMI, it is more probable for women to have atypical symptoms and insignificant CAD compared to men.	The small sample size prevented them from acquiring enough data on men and women to identify a significant difference. There is a need for age matching between the two groups.
Romero et al. (2013) [68]	The retrospective analysis examined the management of therapeutic procedures and the end-point results for underrepresented females, specifically Hispanics, diagnosed with acute myocardial infarction (AMI) in a hospital in which employees are mainly Hispanics.	Males were often diagnosed with AMI and STEMI and received more treatment than females. Hispanics have less access to private insurance compared to NHW and have less access to different treatments for CAD. Patients with private insurance had a decreased death rate in contrast with those without private insurance.	The findings cannot be applied to the entire Hispanic population since the sample size was not large enough. The large number of Hispanic patients and healthcare providers in the analysis may not accurately represent conditions in other hospitals across the country.
Jariwala et al. (2022) [69]	The observational study explored the incidence and pattern of risk determinants of obstructive CAD in women from India aged below 45 years old in contrast to males with an equal age range who have undergone PCI.	Men are more frequently diagnosed with CAD, but women under 45 can also be affected. ACS is the most frequent pattern observed. TVD is mostly associated with men, while SVD is associated with women. Obesity, dyslipidemia, alcoholism, and smoking have a higher incidence in young males, but classic risk determinants are equally prevalent in young females. Cardiogenic shock rates are similar, and in-hospital mortality is low for both sexes.	The study focused only on three states, not the whole of India. Psychological and socio-economic factors were not considered for the study. The study did not dwell on the details of SYNTAX scores, the number of stents placed, or the procedural complications of PCI.
Hasan et al. (2011) [70]	The retrospective observational study evaluated the differences between White people and South Asians in vessel size and angiographic coronary artery disease severity who are undergoing cardiac catheterization.	South Asians exhibited smaller normalized proximal LAD luminal diameters and more severe CAD compared to White patients; TVD was also more pronounced in South Asians. South Asians may have an increased risk of CAD development and mortality when compared to White patients.	This study could not establish causality or control for all potential confounding variables. The sample size was relatively small. Additionally, not including other ethnic groups could have restricted the ability to compare the findings to those of other populations.
Iantorno et al. (2019) [71]	The retrospective cohort analysis assessed the incidence of major cardiovascular incidents, mortality, myocardial infarction, target vessel revascularization (TVR), and stent thrombosis (ST) within 30 and 365 days post-PCI procedure, remarking potential racial disparities.	In comparison to their White peers, Black females show a more elevated incidence of risk determinants of CAD and show these at a younger age. The TVR and ST were greater in Black females.	Only two ethnicities were taken into account. It did not consider other minorities; hence, it overlooks a major chunk of the population, especially in areas where other minorities are concentrated.
Manjunath et al. (2020) [72]	The observational study aimed to explore different ethnic and racial groups and compare the differences in outcomes and treatment.	Excluding Filipinos, all Asian subgroups received coronary angiography less often than NHW. Diagnostics of MI within one year were more probable among Chinese and Asian Indians, in contrast with NHW. CAD risk is high in Asian Indians and Filipinos, whereas Chinese patients demonstrated a lower risk when compared to NHW. Chinese, Filipinos, and Japanese were prescribed more often clopidogrel than NHW after stenting. More than half of Asians are found to have MI in comparison to NHW.	Small sample size of specific subgroups. Data is subject to coding errors, unmeasured lifestyles, and social factors, which may have an impact on the results.
Li et al. (2016) [73]	The cohort study measured the differences in death among different sexes, racial and ethnic groups, and geographic areas with a duration of 3 years.	On the contrary, females are more likely to get the most effective care during hospital release. Female sex and Black race are associated with higher mortality rates.	The study did not investigate lifestyle and social factors after MI. All patients have insurance. Therefore, the study was not generalized to uninsured patients. Patients self-declared their ethnic and racial groups. The sample size was composed of individuals who were 65 years of age and older.