CORRESPONDENCE: LETTER TO THE EDITOR
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Sonia Anand, MD, PhD, FRCPc*,
Keith A.A. Fox, MD, FRCP,
Campbell Joyner, MD, FRCPc,
Salim Yusuf, DPhil, FRCPc on behalf of the CURE Investigators
* McMaster University, Medicine, Hamilton General Hospital, McMaster Clinic, Room 522, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada (Email: anands{at}mcmaster.ca).
In the gender subgroup analysis of the CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events) trial data, we observed that fewer women across all Thrombolysis In Myocardial Infarction (TIMI) risk strata underwent coronary angiography compared to men (1). However, among women who did have significant coronary artery disease (CAD), an equal proportion went on to have coronary revascularization compared to men. We also noted, however, that women in the high-risk acute coronary syndromes (ACS) group were significantly more likely to have refractory angina or be readmitted to a hospital with recurrent angina as compared to men. Dr. Kessler is correct that the differences in revascularization rates could not account for the difference in refractory ischemia/rehospitalization rates we observed. However, if women were equally as likely to have coronary angiograms as men, then more women with significant CAD may have been identified. Subsequent revascularization in this high-risk group may have equalized the rates of refractory ischemia between women and men.
However, we recognize that our association represents a subgroup analysis, which at best can raise a hypothesis but cannot confirm whether it is true. Like Dr. Kessler, we also advocate sex- and gender-based research in cardiovascular disease using sufficient sample sizes and methodology to be confirmatory.
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References
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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]
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