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But most differences in treatment received by men and women following a heart attack may be the result of age bias rather than gender bias, researchers now say.

Women and men aged 50 to 64 received similar levels of medical care after a heart attack, according to a study published in the June 19th issue of the Journal of the American College of Cardiology. Among younger heart patients, women were actually more likely than men to receive aggressive treatment.

But among patients who were aged 65 and older, there is a difference in the sorts of therapy given to women and men, the study’s lead author, Dr. David A. Alter, told Reuters Health.

And this is the age when most women have their heart attacks, added Alter, an assistant professor of medicine at the University of Toronto, a cardiologist at Sunnybrook & Women’s College Health Sciences Center and a scientist with the Institute for Clinical Evaluative Sciences, all in Toronto, Ontario, Canada. So this would make it seem as if women are getting less aggressive care for their disease, he said.

“Men and women present at such different ages with heart disease,” Alter said. “Women present, on average, 10 years later than men. So the two groups are not comparable unless you examine them on a year-by-year basis.”

Several previous studies had found that women were less likely than men to receive aggressive treatment after a heart attack. Alter and his colleagues wondered if the age at which the attack occurred had anything to do with these statistics.

For the new study, the researchers scrutinized the medical records of 16,756 men and 8,941 women who had suffered a heart attack. The investigators checked to see what kinds of care the patients had received after the attack.

In particular, they wanted to know if patients saw a cardiologist or a general practitioner, and if they received coronary angiography–an x-ray procedure that shows whether arteries in the heart are blocked. The researchers also checked to see which patients survived 5 years after their heart attacks.

Alter’s team found that younger female heart patients received more aggressive treatment. “That’s probably because women who have heart disease at a young age are at a higher risk of dying from a heart attack than men of the same age,” Alter said.

Among patients aged 50 to 65, women and men were just as likely to receive angiography and be seen by a heart specialist, the report indicates.

But doctors tended to be less aggressive in treating heart disease in all older patients, particularly women, the researchers found. Still, women in this age group were more likely than men to live more than 5 years after their heart attack.

Alter sees these statistics as justification for the gender-based treatment decisions doctors are making in the elderly. “It would appear that this difference may be appropriate, given the different risks of dying for men and women in this age group,” he said.

Still, doctors might want to rethink how they are treating elderly patients in general, Alter said.

“Among the elderly, if you look at this study, age is a much stronger marker of treatment and survival than gender,” Alter said. “It would appear that the elderly are being undertreated. This might be because doctors fear that the treatments might harm the patients. But they may need to take a closer look at the magnitude of the benefits.”

By Linda Carroll

SOURCE: Journal of the American College of Cardiology 2002;39:1909-1916.