**Question:** All are true about Syndrome X EXCEPT:

A. Syndrome X is a clinical entity characterized by angina pectoris, normal coronary angiography, and impaired glucose tolerance.
B. The pathogenesis of Syndrome X involves coronary artery spasm.
C. Syndrome X is more common in males.
D. Syndrome X is associated with a higher risk of sudden cardiac death.

**Correct Answer: C. Syndrome X is more common in males.**

**Core Concept:** Syndrome X is a clinical syndrome characterized by angina pectoris (chest pain) in the absence of significant coronary artery stenosis on angiography. The pathogenesis involves coronary artery spasm and impaired glucose tolerance. Syndrome X is typically seen in middle-aged, non-diabetic females with a history of stress, obesity, and insulin resistance.

**Why the Correct Answer is Right:** Syndrome X is more common in females due to its association with insulin resistance, obesity, and psychosocial stress factors. This combination of factors predisposes females to coronary artery spasm and angina pectoris without significant obstructive coronary artery disease.

**Why Each Wrong Option is Incorrect:**

A. Syndrome X is characterized by angina pectoris, normal coronary angiography, and impaired glucose tolerance. This statement reflects the typical clinical presentation and diagnostic criteria of Syndrome X.

B. While coronary artery spasm is a crucial pathophysiologic mechanism in Syndrome X, stating that Syndrome X is caused by coronary artery spasm alone is an oversimplification. The syndrome is characterized by a complex interplay of factors including insulin resistance, obesity, and psychosocial stress.

D. Syndrome X is associated with an increased risk of sudden cardiac death. However, the statement is not directly related to the sex distribution of Syndrome X.

**Clinical Pearl:** Understanding the complex interplay of factors associated with Syndrome X is crucial for accurate diagnosis and management. Recognizing Syndrome X in females helps in appropriate treatment options, such as lifestyle modifications, anti-anginal medications, and stress management to prevent sudden cardiac events.