New research shows that men diagnosed with the chest pain called angina did much worse than women, and neither artery-opening angioplasty nor coronary-bypass surgery reduced long-term mortality for either gender.
The study of 1,785 people newly diagnosed with angina at 40 primary-care practices in Scotland confirmed a previously reported difference between men and women that is something of a medical mystery, said Dr Brian Buckley, a research fellow in the National University of Ireland department of general practice, and lead author of an online report in BMJ.
The study, done in collaboration with physicians at the University of Aberdeen in Scotland, found that in the five years following the diagnosis, men were twice as likely to have a heart attack and three times more likely to die of a heart-related condition.
"A lot of practising doctors would have a hunch that would be the case," Buckley said. "Reports of that difference actually go back about 10 years. We pretty well demonstrate that it is a reality."
Asked if he knew the reason for the difference, Buckley said, "I wish I did. We can't tell people why it is so. We need further research to get into the details of why men are doing worse than women."
No difference in survival
Lifestyle factors clearly made a difference in outcome. Smoking doubled the risk of a heart attack and death from all causes, as did obesity, the study authors noted.
Men were more likely than women to have angioplasty or bypass surgery, but the study found no difference in survival for those who had either intervention.
"Bypass surgery does work for many people, there is no doubt about that," Buckley said. "Maybe people who have it should be chosen more carefully than they are. Angina is an early stage of heart disease. At that stage, maybe it doesn't have the effect that might help at a later stage."
The study does indicate the need for emphasising "lifestyle risk factors and optimal medical [drug] treatment" after a diagnosis of angina, Buckley said.
"For many people, the important thing when they are diagnosed with angina is to look at their lifestyle and do what can be done about it," he said. "Medications to reduce blood pressure and cholesterol are good. If you could do that without drugs, so much the better. There are a lot of risk factors that can be managed, and when you do that you are avoiding heart attacks and deaths."
Reasons for difference remain unknown
The findings should be interpreted cautiously, said Dr Gregg C. Fonarow, a professor of medicine at the University of California, Los Angeles, and director of the Ahmanson-UCLA Cardiomyopathy Centre. One reason is that a diagnosis of angina does not pinpoint the cause of the chest pain, he said.
"Angina is a lot of challenges," Fonarow said. "It can mean a lot of different things to a lot of different people."
And the study was observational, meaning that it dealt with all the people seen at the medical practices rather than being a controlled trial in which participants are carefully matched, he said. "Treatment was decided upon not by randomisation but just by defining the condition," Fonarow said. "You need a randomised clinical trial to get definitive results."
But the difference in outcome between men and women appears real, although the reasons for it remain unknown, Fonarow said. "That simply hasn't been established," he said. – (HealthDay News, August 2009)
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