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Studies have shown marked sex disparities in Coronary Artery Diseases (CAD)epidemiology, yet the underlying mechanisms remain unclear. We explored sexdisparities in the coronary anatomy and the resulting haemodynamics in patientswith suspected, but no significant CAD. Left Main (LM) bifurcations werereconstructed from CTCA images of 127 cases (42 males and 85 females, aged 38to 81). Detailed shape parameters were measured for comparison, includingbifurcation angles, curvature, and diameters, before solving the haemodynamicmetrics using CFD. The severity and location of the normalised vascular areaexposed to physiologically adverse haemodynamics were statistically comparedbetween sexes for all branches. We found significant differences between sexesin potentially adverse haemodynamics. Females were more likely than males toexhibit adversely low Time Averaged Endothelial Shear Stress along the innerwall of a bifurcation (16.8% vs. 10.7%). Males had a higher percentage of areasexposed to both adversely high Relative Residence Time (6.1% vs 4.2%, p=0.001)and high Oscillatory Shear Index (4.6% vs 2.3%, p<0.001). However, the OSIvalues were generally small and should be interpreted cautiously. Males hadlarger arteries (M vs F, LM: 4.0mm vs 3.3mm, LAD: 3.6mm 3.0mm, LCX:3.5mm vs2.9mm), and females exhibited higher curvatures in all three branches (M vs F,LM: 0.40 vs 0.46, LAD: 0.45 vs 0.51, LCx: 0.47 vs 0.55, p<0.001) and largerinflow angle of the LM trunk (M: 12.9{\deg} vs F: 18.5{\deg}, p=0.025).Haemodynamic differences were found between male and female patients, which maycontribute, at least in part, to differences in CAD risk. This work mayfacilitate a better understanding of sex differences in the clinicalpresentation of CAD, contributing to improved sex-specific screening,especially relevant for women with CAD who currently have worse predictiveoutcomes.

Sex-Specific Variances in Anatomy and Blood Flow of the Left Main Coronary Bifurcation: Implications for Coronary Artery Disease Risk