Nov. 10, 2005 - Women with chest pain still receive less aggressive treatment than men, even when their cardiovascular risks are the same, a large international study shows.
The study showed that women with a high risk for having heart attacks were about a third less likely than high-risk men to have an invasive diagnostic evaluation called angiography and treatment such as angioplasty and coronary artery bypass graft (CABG) surgery.
The findings were presented today at the American Medical Association's 24th annual Science Reporters Conference in Washington.
Researcher Sonia S. Anand, MD, PhD, tells WebMD that high-risk women are referred less often than men for angiography, the diagnostic procedure in which a catheter is used to inject dye into the arteries to measure blood vessel blockage. The test is used to determine if other invasive treatments are needed, such as angioplasty or CABG.
With angioplasty, artery blockages are opened up with a small balloon-tipped catheter. With CABG, surgeons create new connections to bypass the blocked portions of the coronary arteries.
"There was no real difference between men and women in terms of treatment with drugs like aspirin, statins, and ACE inhibitors," Anand says. "And when they got angiograms they were just as likely to be sent for other procedures if needed. That was encouraging, but you have to identify the problem to treat it."
The study involved more than 12,000 heart patients from 28 countries. All of the participants had been hospitalized between December 1988 and September 2000 with acute coronary syndrome (ACS), a condition that appears as either unstable angina or a mild heart attack.
The patients were evaluated at the time of discharge, again one month later, and then on one to three separate occasions at three-month intervals.
Overall, women were less likely to have angiography, angioplasty, and CABG than men. However, in those that did have angiography and were diagnosed with significant coronary artery disease, there was no difference in the percentage of men and women who received angioplasty or CABG.
"It wasn't that once the disease was documented, physicians ignored women and didn't send them to have operations -- they did," Anand says. "But the initial trigger to send them for the catheterization was much lower for women compared to men."
The study is reported in the Nov. 15 issue of the Journal of the American College of Cardiology.
More Questions Than Answers
Anand says the new findings raise more questions than they answer about the causes of gender differences in the treatment of heart disease. It has been suggested that women's symptoms are often less apparent than men's or that women may be less willing to agree to invasive procedures.
And despite increasing awareness that heart disease is a serious threat to women, the experts say that many doctors may still view it as primarily a man's disease.
Half a million American women die of heart disease each year, according to the American Heart Association. More women die of heart-related causes than of the next six causes of death combined.
"Physicians do treat women and men differently, even though most will tell you that they don't," say University of California, San Francisco Medical Center cardiologist Rita Redberg, MD, MSc. "Unconscious factors may affect people's judgment."
But Redberg tells WebMD that it isn't clear from the study if women were having too few invasive heart procedures or men were having too many.
In the newly reported study, high-risk women did not have a higher incidence of cardiovascular death, heart attack, or stroke than high-risk men, even though they often received less aggressive treatment. They did have more repeat hospital visits for chest pain, however.
Anand says physicians need to take better advantage of tools designed to assess a patient's risk level. High-risk patients in the study -- both men and women -- had four times the risk of heart attack, stroke, and death from cardiovascular causes as low-risk patients.
"All high-risk patients should be treated equally without regard to gender," she says.