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In reply

Yan and colleagues raise an interesting point in regard to the apparent "treatment" effects of the American College of Cardiology GAP system in women compared with men. Because our study was observational in nature, we agree that it is possible that the apparent superior impact of the GAP discharge document in women was confounded by some other factor, either measured or unmeasured.¹ However, we believe not only that the effect may be real but also that known biological differences in coronary heart disease pathophysiologic mechanisms and presentation can explain at least part of this observation.

First, because women present with coronary disease at a later age, on average, than do men, the absolute benefit of combined maximal lifestyle and evidence-based medical therapy may be greater in a cohort with more long-standing disease. Second, because women with acute coronary syndromes have a much greater likelihood of diffuse, small-vessel coronary . . . [Full Text of this Article]

AUTHOR INFORMATION
Kim A. Eagle, MD; Cecelia Montoye, RN; Arthur Riba, MD

RELATED LETTER

Sex Differences in the Benefits of the Guidelines Applied in Practice Project: Are They Due to Sex?
Andrew T. Yan, Raymond T. Yan, and Shaun G. Goodman
Arch Intern Med. 2006;166(21):2405-2406.
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