Women are less likely than men to be diagnosed with coronary heart disease (CHD) if they mention a stressful event, a recent survey concludes. Women’s symptoms are more likely to be seen as psychogenic rather than organic.

In the study, each of 230 primary-care physicians (PCPs) read a vignette describing a man or a woman with a multitude of CHD symptoms and risk factors. Internists and family physicians were targeted, “as they are generally the first medical professionals to assess symptoms and make treatment recommendations,” observes lead researcher Gabrielle R. Chiaramonte, PhD, a postdoctoral associate at Weill Medical College of Cornell University and a clinical fellow at New York-Presbyterian Hospital, both in New York City.

Symptoms included chest pain, chest tightness/pressure, shortness of breath with exertion, and fatigue. Among the risk factors were sedentary lifestyle, somewhat elevated BP, and being moderately overweight or a smoker.

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“The goal was to develop a vignette of a patient with symptoms that would be identified as CHD by most medical professionals,” explains Dr. Chiaramonte.

Half the vignettes indicated the patient had not been sleeping well at night, was anxious about financial matters, and felt under stress at work. The clinician was then asked to specify a diagnosis, recommend treatment, and offer an etiology.

The results showed a gender bias when CHD symptoms were presented in the context of stress, Dr. Chiaramonte reports. Fewer women received CHD diagnoses (15% vs. 56% of men), referrals to cardiologists (30% vs. 62%), or prescriptions for cardiac medication (13% vs. 47%). No evidence of bias was observed when CHD symptoms were presented without stress, and the gender of the physician was irrelevant.

“Clinicians need to be especially careful to rule out CHD before considering an anxiety diagnosis,” Dr. Chiaramonte warns.

The research was presented at the recent Transcatheter Cardiovascular Therapeutics symposium held in Washington, D.C., and sponsored by the Cardiovascular Research Foundation (CRF).

“There is a delay in diagnosing CHD in women, and this is an important step forward in understanding why,” said Alexandra J. Lansky, MD, director of the Women’s Health Initiative at CRF and a cardiologist at NewYork-Presbyterian Hospital/Columbia University Medical Center.