title: Gender differences in the management and clinical outcome of stable angina.
abstract: 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.
  
  
  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.
authors.affiliation: Royal Brompton Hospital, Sydney St, London SW3 6 NP, UK. caroline.daly@imperial.ac.uk.
authors.forename: Caroline
authors.initials: C
authors.lastname: Daly
authors.forename: Felicity
authors.initials: F
authors.lastname: Clemens
authors.forename: Jose L
authors.initials: JL
authors.lastname: Lopez Sendon
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Nicholas
authors.initials: N
authors.lastname: Danchin
authors.forename: Francois
authors.initials: F
authors.lastname: Delahaye
authors.forename: Anselm
authors.initials: A
authors.lastname: Gitt
authors.forename: Desmond
authors.initials: D
authors.lastname: Julian
authors.forename: David
authors.initials: D
authors.lastname: Mulcahy
authors.forename: Witold
authors.initials: W
authors.lastname: Ruzyllo
authors.forename: Kristian
authors.initials: K
authors.lastname: Thygesen
authors.forename: Freek
authors.initials: F
authors.lastname: Verheugt
authors.forename: Kim M
authors.initials: KM
authors.lastname: Fox
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003625:Data Collection; D004562:Electrocardiography / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D011287:Prejudice; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome; D016387:Women's Health