Gender health advocates have long claimed that women with heart symptoms are less likely to undergo advanced cardiac procedures such as cardiac catheterization.

This claim was made in a recent January 20, 2003 article in USA Today titled "Study: Women Undertreated for Heart Disease." The article alleged, "women are treated even less aggressively than men."

The implication of this statement is that women are being discriminated against in seeking life-saving treatment for heart disease. It is true that statistically, women are somewhat less likely than men to undergo cardiac procedures. But this is like comparing apples to oranges, for 3 reasons:

1. Women tend to develop heart disease at an older age than men, so they have a greater chance of developing complications during risky cardiac procedures.

2. Women tend to have smaller hearts than men, which again places them at greater risk of complications and death.

3. Women with undiagnosed heart disease often present with symptoms that resemble heartburn or other non-cardiac conditions.

So doctors are less likely to order cardiac diagnostic tests for these women. Scientific studies that have accounted for differences in age and other risk factors have consistently discounted the existence of sex bias in referral for heart procedures. The conclusions from 5 of these studies are quoted at the end of this Special Report.

According to the latest report, Health United States - 2002, men's death rate from heart disease is 328/100,000, compared to only 221/ 100,000 among women. So while gender health advocates disseminate the myth that women are undertreated for health disease, men face a 48% higher risk of death from heart disease.

Conclusions from Research Studies about the Absence of Sex Bias in Referrals for Cardiac Procedures:

1. "Academic cardiologists made appropriately lower pretest predictions of categories of disease in women with possible coronary artery disease than in men, and these assessments, along with women's lower rate of positive exercise tests, rather than bias based on sex, accounted for the lower rate of catherization among women."

-- Daniel B. Mark. Absence of sex bias in the referral of patients for cardiac catherization. New England Journal of Medicine, April 21, 1994.

2. "Our population-based data indicate that after an ED [emergency department] visit for symptoms of unstable angina, the use of cardiac procedures was lower in women, but after taking into account baseline characteristics, men experienced worse outcomes."

-- Veronique L. Roger, Sex differences in evaluation and outcome of unstable angina. Journal of the American Medical Association February 2, 2000.

3. "After adjustment for differences in clinical and demographic characteristics and clinical presentation, differences according to sex in the use of reperfusion therapy are minimal."

-- John Canto. Relation of race and sex to the use of reperfusion therapy in Medicare beneficiaries with acute myocardial infarction. New England Journal of Medicine, April 13, 2000.

4. "As compared with men, women received somewhat less aggressive treatment during the early management of acute myocardial infarction. However, many of these differences are small, and there is no apparent effect on early mortality."

-- Sandra C. Gan. Treatment of acute myocardial infarction and 30-day mortality among women and men. New England Journal of Medicine, July 6, 2000.

5. "However, the results suggest that, at least in a large province in Canada, sex differences in use of revascularization after cardiac catheterization are due to differences in clinical status and indications rather than to differential access or bias."

-- Richard Smtz. Abstract. July 1, 2002, New England Journal of Medicine.

-Carey Roberts

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