Sex differences in the management of coronary artery disease

Article Abstract:

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.)

Health aspects, Care and treatment, Women, Statistics, Coronary heart disease, Women's health, Discrimination in medical care, Medical care discrimination

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The erythrocyte sedimentation rate in congestive heart failure

Article Abstract:

Based on a study performed in 1936, physicians have believed that the erythrocyte sedimentation rate, or the rate at which oxygen-transporting red blood cells settle in a test tube, was low in patients with congestive heart failure. Studies reporting different results have been consistently ignored, and the 1936 report remained a part of medical folklore. Actually, what the 1936 report said was that the sedimentation rate declined in patients who were getting worse, and increased in patients who were improving with treatment. During the chronic stage of the illness the sedimentation rate was high. In a new study of 242 men and women with chronic heart failure, a depressed sedimentation rate occurred in a state of severe cardiac failure, more severe symptoms, and more circulatory abnormalities. Changes in the sedimentation rate were related to changes in the patient's condition and circulatory status. When the sedimentation rate improved, the patient improved as well, and when it declined, the patient's response to therapy with vasodilating agents was poor as well. In other words, it is the severity, not the presence of heart failure that governs the speed of sedimentation among patients with left ventricular dysfunction. Change in the sedimentation rate was more closely related to mean right atrial pressure before treatment, falling when atrial pressure rose, and vice versa, both before and during treatment. The mechanism for this action seems to be fibrinogen, a protein essential to the clotting process. Unfortunately, the erythrocyte sedimentation rate is affected by many conditions, such as infection, that may occur in patients with congestive heart failure, and the test cannot discriminate among the possible causes. Therefore this test is not very useful in evaluating the condition of patients with heart failure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Prognosis, Congestive heart failure, Fibrinogen, Erythrocyte sedimentation rate

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Ventricular dysfunction and the risk of stroke after myocardial infarction

Article Abstract:

The risk of stroke after having a heart attack may depend on age, strength of the heart, and anticoagulant therapy. Researchers prospectively studied 2231 patients who experienced a reduced left ventricular ejection fraction (LVEF) after having a heart attack. Patients were followed up for an average of 42 months. A total of 103 patients (4.6%) had strokes during the study, some resulting in death. Patients who had strokes were older and had lower LVEFs. Risk factors for stroke were older age, a reduced LVEF of 28% or less, and lack of aspirin or anticoagulant therapy.

Complications and side effects, Risk factors, Heart attack, Stroke (Disease), Stroke

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• Abstracts: Differences in the use of procedures between women and men hospitalized for coronary heart disease. Racial differences in the use of revascularization procedures after coronary angiography

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