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Management of Coronary Artery Disease differs in men and women
It has been observed for some time now that the management of Coronary Artery Disease differs in men and women. The differences exist right from the stage of interpretation of symptoms, non-invasive investigative procedures, cardiac catheterization and finally balloon therapy and bypass surgery if required.
It is a statistical fact that although the incidence of coronary disease is very high in today's day and age days, comparatively less number of women go for cardiac catheterization. The number is less than one fourth. The number of women who undergo interventional treatments like balloon therapy and bypass surgery is even lesser.

It was reported some time ago that women under 60 years of age with symptoms of angina have better prognosis than men under 60 years with history of angina where as women with angina between 60-69 years have a worse prognosis. The mortality rate in this group for women was comparable to that of men with angina regardless of their age.

It is possible that women are older in age by the time they need these procedures and probably have higher incidence of risk factors like diabetes, hypertension and obesity and are more often kept on antianginal medication rather than being subjected to balloon angioplasty or bypass surgery.

The question now arises as to whether coronary angioplasty and bypass surgery is equally effective in both the sexes. May be they are not as effective options in women as in men. Coronary bypass surgery has been found to be associated with greater operative morality and less symptomatic relief in women that in men. Women have coronary arteries with smaller diameters and this may be related to greater operative mortality and less symptomatic relief in them.

It has also been found from various data that women usually have a prolonged duration of angina prior to heart attack or death and there is an unwillingness both amongst the women patients and their physicians to refer them for cardiac catheterization and interventional therapy as they are often stable on medical treatment when their exercise tests are positive for reversible ischemia. This may be alright if all the risk factors are being looked into and taken care of but what happens in practice is that there is a delay in referral of women even after disabling symptoms are present for years, for interventional treatment as compared to men. It appears reasonable to conclude that earlier referral of women would be definitely advantageous both for operative morality risk and symptom relief.

It must be realized that the incidence of coronary artery disease is rising amongest women as never before. This calls for early detection of the disease by stress testing especially when risk factors are present. The later the woman patients are sent for these procedures greater the risk involved.

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