Hvelplund A, Galatius, S

 Mette Madsen,
 Jeppe N. Rasmussen,
 Søren Rasmussen,
 Jan Kyst Madsen,
 Niels P.R. Sand,
 Hans-Henrik Tilsted,
 Per Thayssen,
 Eske Sindby,
 Søren Højbjerg,
 and Steen Z. Abildstrøm

Women with acute coronary syndrome are less invasively examined and subsequently less
treated than men Eur Heart J (2010) 31(6): 684-690published ahead of print November 20, 2009
doi:10.1093/eurheartj/ehp493
 Abstract
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1.

Women and heart disease: why are they still

undertreated?
o Vivencio Barrios, Cardiologist
o Carlos Escobar

Hospital Ramon y Cajal

We read with interest the manuscript of Hvelplund A, et al about the gender differences in
the management of patients with acute coronary syndrome in Denmark [1]. For this
purpose, authors identified all patients admitted to Danish hospitals with acute coronary
syndrome in 2005-07 (9561 women and 16406 men). Authors found that significantly
less women underwent coronary angiography than men (64% versus 78%, P <0.05;
hazard ratio 0.68; 95% CI 0.65-0.70, P <0.0001). Moreover, percutaneous
revascularization was also less likely performed in women compared with men. Previous
studies in different European countries have shown that women are somewhat less
intensively treated, especially regarding invasive procedures [2]. This situation may be
even worse since patients included in these studies had a diagnosis of acute coronary
syndrome. As atypical chest pain is more frequent in women than in men, many women
are not correctly diagnosed of myocardial infarction, or when they are diagnosed,
sometimes it is too late and may not benefit from revascularization [3]. Unfortunately,
these differences do not only occur in acute setting, but they remain during the follow-up.
Thus, when compared gender differences in patients with chronic ischemic heart disease,
women appear to be undertreated and underdiagnosed, what may in part explain the
poorer risk factors control rates observed in this population [4]. Despite cardiovascular
disease is the most important cause of death among women, it seems that many
physicians and patients do not actually realize about the coronary risk in women,
particularly in those with a history of myocardial infarction [5]. Although this could be at
least partially due to confidence in the well-known cardioprotective effect of female
hormones, the fact is that physicians do not adequately diagnose and treat women with
cardiovascular disease. It is very likely that this undertreatment may have an important
role in the cardiovascular prognosis of women. All these data emphasize the need for
ongoing medical education to improve the recognition and management of both acute and
chronic coronary heart disease in women, with the goal of reducing overall
cardiovascular risk.

References

1. Hvelplund A, Galatius S, Madsen M, Rasmussen JN, Rasmussen S, Madsen JK, Sand

NP, Tilsted HH, Thayssen P, Sindby E, Hojbjerg S, Abildstrom SZ. Women with acute
coronary syndrome are less invasively examined and subsequently less treated than men.
Eur Heart J. 2010;31:684-690.

2. Alfredsson J, Stenestrand U, Wallentin L, Swahn E. Gender differences in management

and outcome in non-ST-elevation acute coronary syndrome. Heart. 2007;93:1357-1362.

3. Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute

Coronary Syndromes of European Society of Cardiology, Bassand JP, Hamm CW,
Ardissino D, Boersma E, Budaj A, Fernandez-Aviles F, Fox KA, Hasdai D, Ohman EM,
Wallentin L, Wijns W. Guidelines for the diagnosis and treatment of non-ST-segment
elevation acute coronary syndromes. Eur Heart J 2007;28:1598-1660.

4. Barrios V, Escobar C, Bertomeu V, Murga N, de Pablo C, Calderon A. Sex differences

in the hypertensive population with chronic ischemic heart disease. J Clin Hypertens
(Greenwich). 2008;10:779-786.

5. Mosca L, Banka CL, Benjamin EJ, Berra K, Bushnell C, Dolor RJ, Ganiats TG,
Gomes AS, Gornik HL, Gracia C, Gulati M, Haan CK, Judelson DR, Keenan N,
Kelepouris E, Michos ED, Newby LK, Oparil S, Ouyang P, Oz MC, Petitti D, Pinn VW,
Redberg RF, Scott R, Sherif K, Smith SC Jr, Sopko G, Steinhorn RH, Stone NJ, Taubert
KA, Todd BA, Urbina E, Wenger NK. Evidence-based guidelines for cardiovascular
disease prevention in women: 2007 update. Circulation. 2007;115:1481-1501.

Conflict of Interest:

None declared

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Published April 15, 2010