CORRESPONDENCE: LETTER TO THE EDITOR
Management of Women With Acute Coronary Syndromes
Kenneth Kessler, MD, FACC*
* University of Miami School of Medicine, Division of Cardiology, c/o 26 William Howard Drive, Glen Mills, Pennsylvania 19342 (Email: kmichaelkessler{at}cs.com).
In a recent study published in the Journal, Anand et al. (1) show that women with acute coronary syndromes underwent less coronary angiography and revascularization and had a higher rate of refractory ischemia and rehospitalization than their male counterparts. It is important to understand that these statements are true—true, but not necessarily related. The difference in total revascularization rates in high-risk female and male populations was only 2.5%; this rate difference could not negate the 8.6% difference in refractory ischemia/revascularization rates between genders. Indeed, there is no direct evidence that increasing the revascularization rate would change outcomes in these women. As Anand et al. (1) point out, there is a relative paucity of information regarding the appropriate treatment of coronary artery disease in women. Moreover, their data demonstrate the conundrum physicians face—namely, that women have a lower prevalence of disease but are harder to treat successfully.
Treatment mores demand that a treatment be of proven efficacy and acceptable harm. If a physician hesitates in applying treatment recommendations that are proven for men but not for women, to a female patient, is that gender bias or good evidence-based medicine? The answer: focused, gender-specific, cardiovascular clinical research.
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1. Anand SS, Xie CC, Mehta S, et al. Differences in the management and prognosis of women and men who suffer from acute coronary syndromes J Am Coll Cardiol 2005;46:1845-1851.[Abstract/Free Full Text]
Related Article
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Reply
- Sonia Anand, Keith A.A. Fox, Campbell Joyner, Salim Yusuf on behalf of the CURE Investigators
J. Am. Coll. Cardiol. 2006 48: 2357.
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