This Article Free upon publication Full Text Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Daly, C. Search for Related Content PubMed PubMed Citation Articles by Daly, C. Pubmed/NCBI databases Medline Plus Health Information Angina Related Collections Health policy and outcome research Other diagnostic testing Chronic ischemic heart disease Epidemiology

(Circulation. 2006;113:490-498.)
© 2006 American Heart Association, Inc.

Cardiovascular Disease in Women

Gender Differences in the Management and Clinical Outcome of Stable Angina

Caroline Daly, MB; Felicity Clemens, MS; Jose L. Lopez Sendon, MD; Luigi Tavazzi, PhD; Eric Boersma, PhD; Nicholas Danchin, MD; Francois Delahaye, MD; Anselm Gitt, MD; Desmond Julian, MD; David Mulcahy, MD; Witold Ruzyllo, MD; Kristian Thygesen, MD; Freek Verheugt, MD; Kim M. Fox, MD, on behalf of the Euro Heart Survey Investigators

From the Royal Brompton and Harefield NHS Trust, London, UK (C.D., K.M.F.); London School of Hygiene and Tropical Medicine, London, UK (F.C.); Hospital Universitario Gregorio Maranon, Madrid, Spain (J.L.L.S.); Policlinico S Matteo, Pavia, Italy (L.T.); Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands (E.B.); Hopital Europeen Georges Pompidou, Paris, France (N.D.); Hopital Cardiovasculaire et Pneumologique Louis Pradel, Lyons, France (F.D.); Herzzentrum Luwigshafen, Ludwigshafen, Germany (A.G.); University of Newcastle upon Tyne, Newcastle upon Tyne, UK (D.J.); Adelaide & Meath Incorporating National Childrens’ Hospital, Dublin, Ireland (D.M.); Institute of Cardiology, Warsaw, Poland (W.R.); Aarhus University Hospital, Aarhus, Denmark (K.T.); and University Medical Centre St Radboud, Nijmegen, the Netherlands (F.V.).

Correspondence to Caroline Daly, Royal Brompton Hospital, Sydney St, London SW3 6 NP, UK. E-mail caroline.daly{at}imperial.ac.uk

Received May 13, 2005; revision received November 3, 2005; accepted November 14, 2005.

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.

---

 

CLINICAL PERSPECTIVE

This article has been cited by other articles:

				L. J. Shaw, R. Bugiardini, and C. N. B. Merz Women and ischemic heart disease: evolving knowledge. J. Am. Coll. Cardiol., October 20, 2009; 54(17): 1561 - 1575. [Abstract] [Full Text] [PDF]

				H. Ashikaga and J. E Marine Prevention of atrial fibrillation: another good reason to recommend statins to women? Heart, May 1, 2009; 95(9): 693 - 694. [Full Text] [PDF]

				M A Buser, P T Buser, G M Kuster, L Grize, M Pfisterer, and for the TIME Investigators Improvements in physical and mental domains of quality of life by anti-ischaemic drug and revascularisation treatment in elderly men and women with chronic angina Heart, November 1, 2008; 94(11): 1413 - 1418. [Abstract] [Full Text] [PDF]

				A. R. Pries, H. Habazettl, G. Ambrosio, P. R. Hansen, J. C. Kaski, V. Schachinger, H. Tillmanns, G. Vassalli, I. Tritto, M. Weis, et al. A review of methods for assessment of coronary microvascular disease in both clinical and experimental settings Cardiovasc Res, November 1, 2008; 80(2): 165 - 174. [Abstract] [Full Text] [PDF]

				M. M. Vigoda, L. I. Rodriguez, E. Wu, K. Perry, R. Duncan, D. J. Birnbach, and D. A. Lubarsky The Use of an Anesthesia Information System to Identify and Trend Gender Disparities in Outpatient Medical Management of Patients with Coronary Artery Disease Anesth. Analg., July 1, 2008; 107(1): 185 - 192. [Abstract] [Full Text] [PDF]

				N. Sekhri, A. Timmis, R. Chen, C. Junghans, N. Walsh, J. Zaman, S. Eldridge, H. Hemingway, and G. Feder Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris BMJ, May 10, 2008; 336(7652): 1058 - 1061. [Abstract] [Full Text] [PDF]

				V. Stangl, V. Witzel, G. Baumann, and K. Stangl Current diagnostic concepts to detect coronary artery disease in women Eur. Heart J., March 2, 2008; 29(6): 707 - 717. [Abstract] [Full Text] [PDF]

				F. Andreotti and N. Marchese Women and coronary disease Heart, January 1, 2008; 94(1): 108 - 116. [Full Text] [PDF]

				T. D. Henry, C. L. Grines, M. W. Watkins, N. Dib, G. Barbeau, R. Moreadith, T. Andrasfay, and R. L. Engler Effects of Ad5FGF-4 in Patients With Angina: An Analysis of Pooled Data From the AGENT-3 and AGENT-4 Trials J. Am. Coll. Cardiol., September 11, 2007; 50(11): 1038 - 1046. [Abstract] [Full Text] [PDF]

				P. Collins, G. Rosano, C. Casey, C. Daly, M. Gambacciani, P. Hadji, R. Kaaja, T. Mikkola, S. Palacios, R. Preston, et al. Management of cardiovascular risk in the peri-menopausal woman: a consensus statement of European cardiologists and gynaecologists Eur. Heart J., August 2, 2007; 28(16): 2028 - 2040. [Abstract] [Full Text] [PDF]

				D. H. Birnie MB ChB MD, C. Sambell BSc, H. Johansen PhD, K. Williams MS, R. Lemery MD, M. S. Green MD, M. H. Gollob MD, D. S. Lee MD PhD, and A. S.L. Tang MD Use of implantable cardioverter defibrillators in Canadian and US survivors of out-of-hospital cardiac arrest Can. Med. Assoc. J., July 3, 2007; 177(1): 41 - 46. [Abstract] [Full Text] [PDF]

				E. L. Ding, N. R. Powe, J. E. Manson, N. S. Sherber, and J. B. Braunstein Sex Differences in Perceived Risks, Distrust, and Willingness to Participate in Clinical Trials: A Randomized Study of Cardiovascular Prevention Trials Arch Intern Med, May 14, 2007; 167(9): 905 - 912. [Abstract] [Full Text] [PDF]

				P. Deedwania, P. H. Stone, C. N. Bairey Merz, J. Cosin-Aguilar, N. Koylan, D. Luo, P. Ouyang, R. Piotrowicz, K. Schenck-Gustafsson, P. Sellier, et al. Effects of Intensive Versus Moderate Lipid-Lowering Therapy on Myocardial Ischemia in Older Patients With Coronary Heart Disease: Results of the Study Assessing Goals in the Elderly (SAGE) Circulation, February 13, 2007; 115(6): 700 - 707. [Abstract] [Full Text] [PDF]

				Stable angina who needs revascularisation? DTB, February 1, 2007; 45(2): 12 - 16. [Abstract] [Full Text] [PDF]

				D. W. Dockery and P. H. Stone Cardiovascular Risks from Fine Particulate Air Pollution N. Engl. J. Med., February 1, 2007; 356(5): 511 - 513. [Full Text] [PDF]

				H. M. Krumholz and F. A. Masoudi The Year in Epidemiology, Health Services Research, and Outcomes Research J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1886 - 1895. [Full Text] [PDF]

				A. G. Rosenfeld State of the Heart: Building Science to Improve Women's Cardiovascular Health Am. J. Crit. Care., November 1, 2006; 15(6): 556 - 566. [Abstract] [Full Text] [PDF]

				C. J. Pepine, W. W. Nichols, and D. F. Pauly Estrogen and Different Aspects of Vascular Disease in Women and Men Circ. Res., September 1, 2006; 99(5): 459 - 461. [Full Text] [PDF]

				P. G. Steg and D. Tchetche Pharmacologic management of stable angina: role of ivabradine Eur. Heart J. Suppl., September 1, 2006; 8(suppl_D): D16 - D23. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, K. Fox, M. A. A. Garcia, D. Ardissino, P. Buszman, P. G. Camici, F. Crea, C. Daly, G. De Backer, P. Hjemdahl, et al. Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology Eur. Heart J., June 1, 2006; 27(11): 1341 - 1381. [Full Text] [PDF]

				V. Vaccarino Angina and Cardiac Care: Are There Gender Differences, and If So, Why? Circulation, January 31, 2006; 113(4): 467 - 469. [Full Text] [PDF]