Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality in the United States and worldwide [1,2]. ASCVD involves three main vascular pathologies: cerebrovascular, peripheral, and coronary artery disease. Controlling modifiable risk factors remains the mainstay of current medical therapy and has been shown to significantly reduce ASCVD-related mortality [3]. Established modifiable risk factors include hypertension, dyslipidemia, diabetes, and smoking [2]. In the last 15 years, disparities in the management of such modifiable risk factors in females have been increasingly recognized [4], [5], [6], [7] and attributed to numerous factors, including a lower rate of ASCVD screening, decreased medication adherence, and poor health care access for females [8,9].

These differences result in the inadequate or complete lack of medical management and treatment of atherosclerotic diseases in females and worse clinical outcomes [4], [5], [6], [7],9,10]. For example, statin therapy reduces the risk of myocardial infarction and cardiovascular events in patients with coronary artery disease (CAD) [3,11,12]. Although men have a higher incidence of acute coronary syndrome, females presenting with acute myocardial infarction have higher 1-year reinfarction rates and mortality comparatively [13]. Females with peripheral arterial disease (PAD) are also treated less intensively to achieve cardiovascular risk factor targets, and this lower rate of outpatient pharmacologic treatment with statin, antithrombotic, and antihypertensive medications results in increased readmission rates with critical limb ischemia [14,15]. Furthermore, females with PAD have a longer asymptomatic or latent phase or present with atypical symptoms, and thus often seek medical attention at a later stage and with more advanced disease [16], [17], [18], [19].

Given these worse outcomes in females, despite the advancement of available therapies, there is a need to acknowledge and further analyze sex- and sex-based differences in the treatment of ASCVD. The aim of this systematic review was to summarize such disparities and identify areas for improvement in the medical management of ASCVD. To our knowledge, this is the first study to highlight differences in treatment for females across the spectrum of diseases within ASCVD, namely CAD, PAD, and cerebrovascular disease.