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Women miss out on coronary care

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A study from Spain has shown that women in Spain had significantly worse cardiac disease than men by the time of coronary revascularisation, but were equally at risk from cardiovascular death.

The study was a retrospective case note study of coronary revascularisations in Spain during 1997 which focused specifically on differences in clinical state between the sexes. Two stage cluster sampling ensured a nationally representative sample. The first cluster was of hospitals doing the procedures, and the second was random sampling of records from each chosen hospital. In all, 3645 procedures (1934 percutaneous transluminal coronary angioplasties and 1711 coronary artery bypass grafts) were studied out of an initial number of 27 156.

Women had a higher likelihood of more severe cardiovascular disease, higher surgical risk (odds ratio (OR) 2.6) and risk of associated disease (obesity (OR 1.8); high blood pressure (OR 2.9); or diabetes (OR 2.1)) in univariate analysis. In multivariate analysis, corrected for confounding factors, women were more than twice as likely to have more severe coronary symptoms as men (OR 2.4). Further work will be required to distinguish the many possible reasons—biological, behavioural, cultural, doctors’ attitudes towards the sexes, late diagnosis, or different treatment.