Coronary artery disease (CAD) is a leading cause of death of women and men worldwide. CAD’s impact on women traditionally has been underappreciated due to higher rates at younger ages in men. Microvascular coronary disease disproportionately affects women. Women have unique risk factors for CAD, including those related to pregnancy and autoimmune disease. Trial data indicate that CAD should be managed differently in women. In this review, we will examine risk assessment for CAD in women, CAD’s impact on women, as well as CAD’s female-specific presentation and management strategies.