Sex differences in the management of coronary artery disease

Although over 500,000 women die from coronary heart disease each year in the United States, recent studies indicate that males with heart disease receive more aggressive treatment than females. Women suffer angina as their chief symptom more often than men, but are referred for noninvasive tests less frequently than men. In addition, when noninvasive testing indicates coronary heart disease, women are less likely than men to be referred for invasive tests and coronary bypass surgery. It is possible that diagnostic tests are less accurate in women; this would account for decisions to order special diagnostic tests less frequently for female patients. But, if this is not the case, women with heart disease may be receiving poorer medical care than men. Gender-related differences in the diagnosis and treatment of coronary heart disease were assessed among men and women who had suffered a heart attack. These patients were enrolled in a drug trial evaluating the use of a medication for a type of abnormal heart function. Of the 2,231 participants, 389 were women. Twenty-six percent of the men and 24 percent of the women had angina prior to their heart attacks, with 19 percent of the men and 18 percent of the women having angina at least three weeks prior to the attack. The frequency of angina attacks and treatments for them were similar in both sexes, however women reported greater disability resulting from angina. Men were more likely to undergo diagnostic cardiac catheterization than women (27.3 percent versus 15.4 percent), and were more likely to have bypass surgery (12.7 percent versus 5.9 percent). These differences were consistent when evaluating only patients who had a prior heart attack and only those with a history of angina. When controlling for other factors, men were twice as likely to receive these tests and treatments than women, despite the similarities of their conditions. These results indicate that men with heart disease receive cardiac catheterization and bypass surgery more often than women with similar levels of disease. Whether this means that these treatments are overused in men or underused in women is unknown. Further research must assess the outcomes of diagnostic tests and treatments in female patients with coronary heart disease. (Consumer Summary produced by Reliance Medical Information, Inc.)