LAUSR

The authors are to be commended in analyzing and putting together an excellent body of work from a large database that once again reveals disparities in the cardiovascular outcomes between men and women. In this report, the focus was on the treatment and outcomes of patients with ST-elevation myocardial infarction (STEMI) in the state of New York between 2013 and 2015. The authors went a step further to minimize a few clinical realities that might skew the findings, namely omitting Takotsubo STEMI patients, patients with coronary dissection, patients who had thrombolytic therapy, as well as patients with left bundle branch. The findings remained the same. This report, which echoes many others on the subject, found that women do not fare as well as men. Specifically, women with STEMI underwent revascularization less frequently, died more often, and even women had higher 30-day mortality when revascularized. The NHLBI and American Heart Association ongoing campaign, “Go Red for Women,” is an ongoing effort to make women know their risk for heart disease and take action to reduce their personal risk. The fact that too many women still do not realize heart disease is their primary killer and too few know what are considered healthy levels for cardiovascular risk factors such as blood pressure and cholesterol is unacceptable. This is not the first report to find differences in time to treatment (they did not address this aspect as the data were not readily available), differences in revascularization rates, and disparate outcomes in women than men, and it will not be the last. The actual question that we should all be asking is “when will we celebrate the report of similar outcomes for men and for women”? Given the reality of sexual differences being protective for women before menopause, it is unlikely that outcomes will be the same but with proper statistical corrections, we should be able to develop a bar for optimal therapy and outcomes for both sexes, despite finding higher mortality in one group. This report is retrospective and thus suffers the same problems as many others from the baseline group differences; in this case, very significant difference in median age between the men and women (71 vs. 61 years, respectively), differences in race/ethnicity between the men and women, and much higher history of hospitalization within the year (24 vs. 15%, respectively). Simply put and statistically significant, women with STEMI in this large database had higher rates of comorbid conditions as is typical of these retrospective looks. In the interim, we do need to focus on the reported difference that can be addressed, namely that women often feel cardiac symptoms differently than men, that the diagnosis of ischemic heart disease in women is more likely to be delayed or missed, and that women often procrastinate or worse, and ignore their symptoms longer because they are too busy or too tired to seek medical attention. We also need to be 100% certain that we, as providers, give every man and woman a wide berth regarding possible ischemic symptoms and to particularly do so in patients at increased risk. Yes, we may at times seem to be from different planets with regard to how we think and feel and, in our relationships, so let us celebrate and enjoy the differences, but we are all one in this health game.