27 In summary, the management of CVD in men and women is obviously different, and these differences are partly due to a gender bias in favor of men. While some studies did not find a gender bias in the management and outcome of patients with acute coronary artery disease,28 unstable angina,29 and in selection for coronary angiography and revascularization early after MI,30 others did.31,32 For example, in a large European study, Daley et al32 Identified significant gender bias at multiple levels in the investigation and management Inhibitors,research,lifescience,medical of stable angina (Figure 2) Figure 2. Effect of gender on the investigation and management of new-onset stable angina from the Euro Heart Survey of Stable

Angina.31 Adjusted ORs and 95% Cls for women compared with men are shown. ORs were adjusted for age, gender, comorbidity, duration of … Female patients were referred significantly less often for either noninvasive or invasive investigation than male patients, and were less likely to undergo revascularization or optimal secondary Inhibitors,research,lifescience,medical preventive medication, even in the presence of confirmed coronary disease. They were twice as likely to suffer death Inhibitors,research,lifescience,medical or nonfatal

MI within a 1year follow-up period. In an Irish population of 15 590 patients with ischemic heart disease, compared with male patients, female patients were less likely to receive a secondary preventive medication Inhibitors,research,lifescience,medical (ß-blocker, aspirin, anglotensin-converting enzyme inhibitor). However, they were more likely to receive anxiolytics (benzodiazepines).33 A similar gender bias was detected by a Scottish study,34 where gender difference was independent of age, adverse circumstances, and comorbidities, and even increased over time. Gender bias has also been reported with respect to cardiac rehabilitation. Most studies report poorer program uptake, poorer adherence, and buy Bosutinib higher dropout rates for women than for men, although data indicate that women show Improvements the same as or greater than those Inhibitors,research,lifescience,medical of men.26 This seems not only due to

psychosocial barriers in women themselves (low self-esteem, multiple care-giving roles, economic concerns), but also to less strong recommendations for rehabilitation. Gender stereotypes in medicine may have fatal consequences Histone demethylase as in the case of CVD, and the lack of secondary preventive medication in women may additionally expose them to a higher risk of MI and death, and may be one reason for the slower decline in female mortality rates. Gender differences in traditional cardiac risk factors Traditional cardiac risk factors are assumed to be essentially the same for men and women, although Important quantitative differences in physiology and pathology have been observed. Women have smaller artery dimension, different electrical properties, and different plaque composition and development.