title: Interpreting angina: symptoms along a gender continuum.
abstract: 'Typical' angina is often used to describe symptoms common among men, while 'atypical' angina is used to describe symptoms common among women, despite a higher prevalence of angina among women. This discrepancy is a source of controversy in cardiac care among women.
  
  
  
  To redefine angina by (1) qualitatively comparing angina symptoms and experiences in women and men and (2) to propose a more meaningful construct of angina that integrates a more gender-centred approach.
  
  
  
  Patients were recruited between July and December 2010 from a tertiary cardiac care centre and interviewed immediately prior to their first angiogram. Symptoms were explored through in-depth semi-structured interviews, transcribed verbatim and analysed concurrently using a modified grounded theory approach. Angiographically significant disease was assessed at ≥70% stenosis of a major epicardial vessel.
  
  
  
  Among 31 total patients, 13 men and 14 women had angiograpically significant CAD. Patients describe angina symptoms according to 6 symptomatic subthemes that array along a 'gender continuum'. Gender-specific symptoms are anchored at each end of the continuum. At the centre of the continuum, are a remarkably large number of symptoms commonly expressed by both men and women.
  
  
  
  The 'gender continuum' offers new insights into angina experiences of angiography candidates. Notably, there is more overlap of shared experiences between men and women than conventionally thought. The gender continuum can help researchers and clinicians contextualise patient symptom reports, avoiding the conventional 'typical' versus 'atypical' distinction that can misrepresent gendered angina experiences.
authors.affiliation: Harvard TH Chan School of Public Health , Cambridge, Massachusetts , USA.
authors.forename: Catherine
authors.identifier: 0000-0001-9542-8453
authors.initials: C
authors.lastname: Kreatsoulas
authors.affiliation: Faculty of Health Sciences , McMaster University , Hamilton, Ontario , Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Crea-Arsenio
authors.affiliation: Faculty of Health Sciences , McMaster University , Hamilton, Ontario , Canada.
authors.forename: Harry S
authors.initials: HS
authors.lastname: Shannon
authors.affiliation: Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Interventional Cardiology, Hamilton General Hospital, Hamilton, Ontario, Canada.
authors.forename: James L
authors.initials: JL
authors.lastname: Velianou
authors.affiliation: Faculty of Health Sciences , McMaster University, Centre for Health Economics & Policy Analysis , Hamilton, Ontario , Canada.
authors.forename: Mita
authors.initials: M
authors.lastname: Giacomini
keywords: CORONARY ARTERY DISEASE