Gender Differences in Diagnosis and Management of Coronary Disease

Women and men share a leading cause of death, coronary heart disease. The genders differ, however, in their manifestations of coronary disease and response to therapy. Diagnosis of coronary disease is more difficult in women, in whom the predictive value of treadmill testing is significantly poorer and interpretation of nuclear images of the heart is complicated by breast artifact. A gender disparity is also apparent in rates of diagnostic coronary angiography, although this may reflect overuse in men as much as underuse in women. During myocardial infarction, women wait longer than men before seeking medical attention, are less likely to be eligible for thrombolytic therapy, and, if eligible, are less likely to receive thrombolytics. In-hospital mortality following myocardial infarction is higher in women, and this difference is not solely attributable to age. Following myocardial infarction, women are less likely to be referred for angiography; following angiography, women are less likely to be referred for revascularization. This apparent reticence in referral patterns for revascularization may be appropriate in view of the increased morbidity and mortality among women undergoing coronary angioplasty or coronary artery bypass grafting. Diagnostic practices and treatment of coronary disease differ in men and women. The appropriateness of these approaches remains to be established.