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(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.

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CLINICAL PERSPECTIVE

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