Gender Differences in the Management and Clinical Outcome of Stable Angina

Abstract

on behalf of the Euro Heart Survey Investigators Background-We sought to examine the impact of gender on the investigation and subsequent management of stable angina and to assess gender differences in clinical outcome at 1 year. Methods and Results-The Euro Heart Survey of Stable Angina enrolled patients with a clinical diagnosis of stable angina on initial assessment by a cardiologist. Baseline clinical details and cardiac investigations planned or performed within a 4-week period of the assessment were recorded, and follow-up data were collected at 1 year. A total of 3779 patients were included in the survey; 42% were female. Women were less likely to undergo an exercise ECG (odds ratio, 0.81; 95% CI, 0.69 to 0.95) and less likely to be referred for coronary angiography (odds ratio, 0.59; 95% CI, 0.48 to 0.72). Antiplatelet and statin therapies were used significantly less in women than in men, both at initial assessment and at 1 year, even in those in whom coronary disease had been confirmed. Women with confirmed coronary disease were less likely to be revascularized than their male counterparts and were twice as likely to suffer death or nonfatal myocardial infarction during the 1-year follow-up period (hazard ratio, 2.09; 95% CI, 1.13 to 3.85), even after multivariable adjustment for age, abnormal ventricular function, severity of coronary disease, and diabetes. Conclusions-Significant gender bias has been identified in the use of investigations and evidence-based medical therapy in stable angina. Women were also less likely to be revascularized. The observed bias is of particular concern in light of the adverse prognosis observed among women with stable angina and confirmed coronary disease.

Gender and sex: issues in medical education

“…Physicians in their turn also tend to be slower in relating chest pain in women to coronary diseases, even more so if women present symptoms in emotional rather than matter-of-fact ways [14]. Women are also given exercise ECG and coronary angiography tests less frequently and receive therapy in line with prevailing guidelines less often [15]. Apparently, physicians work on the basis that angina pectoris in women is of an innocent nature.…”

Gender Bias in Medicine

“…There is also evidence that women, for no apparent medical reason, are not offered the same treatment as men, a phenomenon that raises the question of gender bias. Many studies, for example, show that women are less likely than men to receive more advanced diagnostic and therapeutic interventions [6][7][8][9][10][11].…”

Sex Differences in Clinical Characteristics, Psychosocial Factors, and Outcomes Among Patients With Stable Coronary Heart Disease: Insights from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) Trial

“…A study of 3779 patients with stable angina showed that in women with proven coronary disease, revascularization procedures were used less frequently than in men 7. Meanwhile, at 1 year of follow‐up, the combination of antiplatelet and lipid‐lowering therapies was prescribed less for women than for men.…”

“…Female patients have more complex signs and symptoms of ischemia, and the variation in reproductive hormone levels may play a role in CHD pathophysiology and response to treatment. In both acute and chronic settings, several studies have shown that women, compared with men, are less aggressively treated with evidence‐based therapies and less often undergo invasive procedures 4, 5, 6, 7, 8. However, less is known about the relationship of psychosocial factors, sex, and clinical outcomes among patients with CHD 9, 10, 11, 12, 13.…”