Link to Publisher's site
Clin Cardiol. 2005 Aug; 28(8): 389–393.
Published online 2006 Dec 5. doi: 10.1002/clc.4960280809
PMCID: PMC6654010
PMID: 16144216

Physicians' attitudes toward preventive therapy for coronary artery disease: Is there a gender bias?

Akram Abuful, M.D., 1 Yori Gidron, PH.D., 2 and Yaakov Henkin, M.D.corresponding author 1

Abstract

Background: While much of the gender difference in the treatment of coronary artery disease (CAD) results from the fact that the women being treated are older and have more co‐morbidities, it remains to be established whether a true gender bias exists. We compared physicians' attitudes and practice toward preventive therapy in men and women with CAD.

Hypothesis: Physicians perceive the prevention of CAD in men as more important than in women.

Methods: In the “attitude study,” we obtained data on the attitudes of 172 physicians toward treatment, using hypothetical case histories of 58‐year‐old male and postmenopausal female patients with identical clinical and laboratory data and mild coronary atherosclerosis on angiography. In the “actual practice study,” we evaluated the lipoprotein levels and prescription of lipid‐lowering medications from medical records of 344 male and female patients with angiographic evidence of CAD.

Results: In the hypothetical case histories, physicians in general considered the male patient to be at higher risk and prescribed aspirin (91 vs. 77%, p < 0.01) and lipid‐lowering medications (67 vs. 54%, p < 0.07) more often for the male patient. Evaluation of medical charts of patients with CAD revealed that in patients with baseline low‐density lipoprotein cholesterol > 110 mg/dl, 77% of the males received a lipid‐lowering medication, compared with only 47% of the female patients (p < 0.001).

Conclusions: We found evidence for a gender bias in the attitude as well as in actual practice of secondary prevention toward patients with CAD. While the proportion of male patients receiving lipid‐lowering medications appears appropriate, the proportion of women receiving such treatment remains undesirable.

Keywords: coronary artery disease, prevention, attitude, physicians, gender bias

Full Text

The Full Text of this article is available as a PDF (29K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
1. Hoyert DL, Kochanek KD, Murphy SL: Deaths: Final data for 1997. Natl Vital Stat Rep 1999; 47: 1–104 [PubMed] [Google Scholar]
2. Rich‐Edwards JW, Manson JE, Hennekens CH, Buring JE: Medical progress: The primary prevention of coronary heart disease in women. N Engl J Med 1995; 332: 1758–1766 [PubMed] [Google Scholar]
3. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation 2002; 106: 3157–3421 [PubMed] [Google Scholar]
4. Mosca L, Manson JE, Sutherland SE, Langer RD, Manolio T, Barrett‐Connor E: Cardiovascular disease in women: A statement for healthcare professionals from the American Heart Association. Circulation 1997; 96: 2468–2482 [PubMed] [Google Scholar]
5. Cardiovascular Health Branch, Division of Chronic Disease Control and Community Intervention, National Center for Chronic Disease Prevention and Health Promotion, CDC : Trends in ischemic heart disease mortality—United States, 1980‐1988. Morb Mortal Week Rep 1992; 41: 548–556 [Google Scholar]
6. Ayanian JZ, Epstein AM: Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med 1991; 325: 221–225 [PubMed] [Google Scholar]
7. Clarke KW, Gray D, Keating NA, Hampton JR: Do women with acute myocardial infarction receive the same treatment as men? Br Med J 1994; 309: 563–566 [PMC free article] [PubMed] [Google Scholar]
8. Kostis JB, Wilson AC, O'Dowd K, Gregory P, Chelton S, Cosgrove NM, Chirala A, Cui T: Sex differences in the management and long‐term outcome of acute myocardial infarction: A statewide study. Myocardial Infarction Data Acquisition System (MIDAS) Study Group. Circulation 1994; 90: 1715–1730 [PubMed] [Google Scholar]
9. Shaw LJ, Miller DD, Romeis JC, Kargl D, Younis LT, Chaitman BR: Gender differences in the noninvasive evaluation and management of patients with suspected coronary artery disease. Ann Intern Med 1994; 120: 559–566 [PubMed] [Google Scholar]
10. Gottlieb S, Harpaz D, Shotan A, Boyko V, Leor J, Cohen M, Mandelzweig L, Mazouz B, Stern S, Behar S: Sex differences in management and outcome after acute myocardial infarction in the 1990s: A prospective observational community‐based study. Circulation 2000; 102: 2484–2490 [PubMed] [Google Scholar]
11. Ghali WA, Faris PD, Galbraith PD, Norris CM, Curtis MJ, Saunders LD, Dzavik V, Mitchell LB, Knudtson ML: Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease: Sex differences in access to coronary revascularization after cardiac catheterization: Importance of detailed clinical data. Ann Intern Med 2002; 136 (10): 723–732 [PubMed] [Google Scholar]
12. Krumholz HM, Douglas PS, Lauer MS, Pasternak RC: Selection of patients for coronary angiography and coronary revascularization early after myocardial infarction: Is there evidence for a gender bias? Ann Intern Med 1992; 116: 785–790 [PubMed] [Google Scholar]
13. Roeters van Lennep JE, Zwinderman AH, Roeters van Lennep HW, Westerveld HE, Plokker HW, Voors AA, Bruschke AV, van der Wall EE: Gender differences in diagnosis and treatment of coronary artery disease from 1981 to 1997. No evidence for the Yentl syndrome. Eur Heart J 2000; 21: 911–918 [PubMed] [Google Scholar]
14. Miller M, Byington R, Hunninghake D, Pitt B, Furberg CD: Sex bias and underutilization of lipid‐lowering therapy in patients with coronary artery disease at academic medical centers in the United States and Canada. Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT) Investigators. Arch Intern Med 2000; 160 (3): 343–347 [PubMed] [Google Scholar]
15. Di Cecco R, Patel U, Upshur RE: Is there a clinically significant gender bias in post‐myocardial infarction pharmacological management in the older (> 60) population of a primary care practice? BMC Fam Pract 2002; 3: 8–12 [PMC free article] [PubMed] [Google Scholar]
16. Lloyd G, Cooper A, McGing E, Chia H, Jackson G: Are women discriminated against for lipid lowering therapy? Results from a prospective cohort of women with coronary artery disease. Int J Clin Pract 2000; 54: 217–219 [PubMed] [Google Scholar]
17. Wood D: Recommendations of the Second Task Force of European and other Societies on Coronary Prevention. Eur Heart J 1998; 19: 1434–1503 [PubMed] [Google Scholar]
18. Harats D, Rubinstein A: Joint recommendations of Israel medical societies for prevention of coronary heart disease and atherosclerosis. Harefuah 2000; 138: 66–74 (in Hebrew) [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley-Blackwell

Formats: