"How does CAD differ in women?"

The use of aspirin, heparin, and beta blockers are less frequent among women. Thrombolysis when used in women is on an average 14 minutes later. Unfortunately, women also experience a greater incidence of bleeding complications from thrombolytic agents. Cardiac catheterizations, angioplasty and bypass graft surgery are used less frequently among women. Women have a higher mortality rate than men, and a greater incidence of cardiac rupture and sudden death from thrombolytic therapy.

The medical community is frequently blamed for under-diagnosing and under-treating women with heart disease. We often wonder whether indeed there is a physician bias.

Symptom of chest pain or shortness of breath: The prevalence of CAD is less in women than in men. For example, a 60-year-old man and a 60-year-old woman presenting with identical symptoms of angina, the man has a greater than 90% chance of having significant CAD, whereas the woman has just less than 50%. In general, ER physicians and the community, as a whole, is attuned to the fact of men presenting with AMI or sudden death as their first manifestation of CAD, whereas in women the mode of presentation is atypical.

There is a certain level of genuine confusion, and a clinically apparent built-in bias among physicians in responding with the same level of urgency in women in comparison to men.

The problem is further complicated by the fact that initial screening tests, like stress tests, have reduced sensitivity in women, making diagnosis more difficult. Even with more advanced diagnostic tests like stress echocardiography and dobutamine echocardiography, it is impossible to reach a high level of diagnostic accuracy in women. There are more false-positive and false-negative results in women, leading to errors on either side of the spectrum. That is one of the reasons why women get less coronary angiograms than men. When they do get an angiogram for similar indications, women have more percentages of normal coronary arteries than men.

Hence, there is a certain level of genuine confusion, and a clinically apparent built-in bias among physicians in responding with the same level of urgency in women in comparison to men. However, it has been proven beyond doubt that women in general are about 40% less likely to be referred for an angiogram no matter what. In particular, African American females are about 60% less frequently referred for coronary angiograms than Caucasian males, suggesting a clear signal of physician bias. This is an area where the medical profession has to pay a lot more attention in giving credit to atypical presentations of CAD, choosing the right diagnostic test, and showing greater willingness to refer women for angiograms.

African American females are about 60% less frequently referred for coronary angiograms than Caucasian males, suggesting a clear signal of physician bias.

When it comes to hypertension are woman different?