Bongard Vanina, Grenier Olivier, Ferrières Jean, Danchin Nicolas, Cantet Christelle, Amelineau Elisabeth, Cambou Jean-Pierre
Department of Epidemiology, INSERM U558, Faculté de Médecine, 37, allées Jules Guesde 31-073, Toulouse, Cedex 7, France.
Int J Cardiol. 2004 Feb;93(2-3):217-23. doi: 10.1016/j.ijcard.2003.04.003.
The problem of a possible gender bias in coronary heart disease management is still controversial. We studied gender differences in secondary preventive drug prescriptions and in referral to cardiac rehabilitation after acute coronary events in France.
An observational survey was carried out in 1998-1999 in 150 French intensive cardiac care units. A sample of 2626 consecutive patients admitted for myocardial infarction or unstable angina and alive at discharge was included. Data were retrospectively collected from medical records after discharge.
The sample was composed of 1921 men and 705 women. At discharge, antiplatelet agents were prescribed in 93.4% of men and 91.5% of women (p=0.09), beta-blockers in 73.4% and 63.7% (p<0.0001), angiotensin-converting enzyme (ACE) inhibitors in 39.9% and 44.3% (p<0.05), and statins in 47.0% and 40.7% (p<0.01). The percentage of subjects referred to a cardiac rehabilitation program at discharge was 26.2% in men and 15.5% in women (p<0.0001). In multivariate analysis, taking into account confounding factors, gender did not appear as an independent determinant of drug prescriptions. Conversely, being a woman was independently associated with a lower probability to be referred to a cardiac rehabilitation program at discharge (adjusted female-to-male odds ratio: 0.44 (95% confidence interval: [0.31-0.64], p<0.0001).
In this study, gender was not an independent determinant of secondary preventive drug prescriptions after acute coronary events. Conversely, we found a gender bias in referral to cardiac rehabilitation programs at discharge.
冠心病治疗中可能存在的性别偏见问题仍存在争议。我们研究了法国急性冠脉事件后二级预防药物处方及心脏康复转诊方面的性别差异。
1998 - 1999年在法国150个心脏重症监护病房进行了一项观察性调查。纳入了2626例因心肌梗死或不稳定型心绞痛入院且出院时存活的连续患者样本。出院后从病历中回顾性收集数据。
样本包括1921名男性和705名女性。出院时，93.4%的男性和91.5%的女性开具了抗血小板药物（p = 0.09），73.4%的男性和63.7%的女性开具了β受体阻滞剂（p < 0.0001），39.9%的男性和44.3%的女性开具了血管紧张素转换酶（ACE）抑制剂（p < 0.05），47.0%的男性和40.7%的女性开具了他汀类药物（p < 0.01）。出院时被转诊至心脏康复项目的患者比例男性为26.2%，女性为15.5%（p < 0.0001）。在多变量分析中，考虑到混杂因素，性别并非药物处方的独立决定因素。相反，女性在出院时被转诊至心脏康复项目的概率较低（调整后的女性与男性比值比：0.44（95%置信区间：[0.31 - 0.64]，p < 0.0001）。
在本研究中，性别并非急性冠脉事件后二级预防药物处方的独立决定因素。相反，我们发现在出院时心脏康复项目的转诊方面存在性别偏见。
