356 Chapter 10bypass surgery even when they have compa-
rable medical profiles (Travis, 2005). Women
also are only half as likely as men to receive
implantable cardioverter-defibrillators to
prevent life-threatening arrhythmias (i.e.,
irregular heartbeats; Curtis et al., 2007).
Although earlier studies showed that women
have poorer outcomes from some of these
procedures compared to men, more recent
studies suggest that the sex difference in mor-
tality following the insertion of a coronary
stent or bypass surgery may be disappearing
(Ishihara et al., 2008; Travis, 2005).
One reason that women are less likely
to be referred for some of these treatments
than men is that disease is more advanced in
women than men when it is detected. Why
is that the case? It turns out that heart dis-
ease is more difficult to detect in women
than men. Men are more likely to have clas-
sic chest pain, and women are more likely
to have a variety of ambiguous symptoms,
such as nausea, shortness of breath, and back
pain (Vitale et al., 2007). This could partly
explain why one study showed that women
with heart problems were more likely than
men with heart problems to be mistakenly
discharged from hospital emergency rooms
(Pope et al., 2000). When heart damage was
assessed 24 to 72 hours later, missed diagno-
ses were more common in women than men.
However, even when symptoms are the
same, physicians appear less likely to diag-
nose heart disease in women than men. In an
experimental study, a videotape of a patient
with key symptoms of heart disease (chest
pain, stress, heartburn, low energy) was pre-
sented to family physicians who were asked
to indicate the nature of the problem and
the certainty of their opinion (Maserejian
et al., 2009). The patient was either male or
female and either 55 or 75 years old. Regard-
less of the diagnosis physicians made, theythe leading cause of death of women as well
as men, women are less likely than men to re-
ceive information from their physician about
the risks of heart disease (Grunau et al., 2009).
In terms of prevention, women are less likely
than men to have a fasting cholesterol test
taken and are less likely than men to be placed
on lipid-lowering drugs (Hippisley-Cox
et al., 2001). However, these drugs appear to
be more effective in preventing heart disease
in men than in women (Petretta et al., 2010).
Women are less likely than men to re-
ceive each of the three major treatments for
heart disease (Kattainen et al., 2005; Sacco,
Cerone, & Carolei, 2009; Vitale et al., 2007).
One treatment is a type of drug therapy, re-
ferred to asthrombolytic therapy. Throm-
bolytic drugs are administered during the
course of a heart attack with the hope of
opening the arteries, increasing blood flow,
and reducing the amount of heart dam-
age. Despite the fact that thrombolytic ther-
apy has been shown to be more effective in
women than men (Sacco et al., 2009), it is
used less often in women than in men. A
second treatment for heart disease ispercu-
taneous transluminal coronary angioplasty
(PTCA). With PTCA, a balloon is placed on
the tip of a catheter, which is then threaded
through the coronary arteries. At the site of
the blockage, the balloon is inflated in an ef-
fort to increase the diameter of the artery and
thus increase blood flow. Women are less
likely than men to be referred for coronary
angioplasty. A similar procedure is used to
insert a coronary stent to help keep the artery
open. The third major treatment for heart
disease iscoronary artery bypass surgery.
Arteries are taken from the person’s leg or
chest wall and used to bypass the blockages
of the arteries that supply blood to the heart.
This is a major surgical procedure. Women
are less likely than men to be referred forM10_HELG0185_04_SE_C10.indd 356 6/21/11 8:54 AM