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Snapshot of Global Cardiac Care: Women in Latin America and Eastern Europe Don't Fare as Well

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Duke Health News 919-660-1306

DALLAS, TX -- Women in Latin America and, to a lesser
extent, those in Eastern Europe receive aggressive treatments
for potential heart attacks less frequently than men, and when
they do receive this care, it tends to be administered later.
In these regions, the incidence of death from heart disease is
higher in women.

But in the more industrialized areas of the world, like
North America and Western Europe, women and men receive
practically the same treatment and have similar outcomes.
These are the findings gleaned from a new analysis of data
collected during the recent international heart trial known as
PURSUIT. The 27-nation trial tested the effectiveness of the
drug eptifibatide in more than 10,000 patients coming into
emergency rooms with symptoms of a heart attack.

In the process of gathering data about the drug, researchers
also collected information on whether or not patients received
aggressive diagnostic or treatment procedures such as cardiac
catheterizations, angioplasties or coronary artery bypass
procedures, and how well they did.

"These data give us a snapshot of the state of heart care,"
said Lisa Berdan, researcher at the Duke Clinical Research
Institute (DCRI) and lead author of the current study. "The
disparity in the treatment of women may not be solely a
resource issue, but may involve cultural factors as well."

Berdan prepared the results of the DCRI study for
presentation Tuesday (Nov. 10) at the 71st scientific sessions
of the American Heart
Association
meeting.

Of the 10,948 patients enrolled in PURSUIT, 35.2 percent
were women, and they were older (66 vs. 62) and had higher
rates of hypertension and diabetes than men. Patients were
grouped in four regions: North America, Latin America, Western
Europe and Eastern Europe.

"Previous international trials have shown that compared with
men, women who present with acute coronary syndromes (symptoms
that may lead to a heart attack) tend to be older, have more
concurrent medical problems, and have more risk factors for
heart disease," Berdan said. "This explains why women are worse
off when they arrive at hospital, but it doesn't explain the
differences in treatment. In North America and Western Europe,
for example, women seemed to do as well as men after aggressive
treatment."

When the researchers then looked at when women received
these aggressive diagnostic and treatment procedures, they
found that in Latin America and Eastern Europe these procedures
were performed later.
In Latin America, women waited an average of 4.9 days before
receiving a catheterization; men waited 4.2 days. In Eastern
Europe, women waited 13.2 days, men waited 11 days. As a
comparison, North American men and women wait an average 1.1
days.

"In Latin America and Eastern Europe, women reported more
episodes of chest pain, but they received fewer cardiac
catheterizations," Berdan said. "Why they underwent fewer
catheterizations despite more episodes of chest pain is the
million-dollar question. If you treat patients less
aggressively and later in the process, they may be more likely
to suffer a heart attack or die."

In Latin America, the incidence of death among women was
16.7 percent, while for males, it was 12.7 percent. In Eastern
Europe, the rate was 10.4 percent for women, and 7.8 percent
for men. As a comparison, in North America, the incidence for
women was 5.8 percent and for men, 6.9 percent.
For cultural reasons, because women tend to stay home and
perform more domestic duties, they are less likely to seek
medical care than men, Berdan said.

"When we talked to doctors in Latin America and Eastern
Europe, they couldn't explain the differences in treatment,"
she continued. "They could only say that women were sicker when
they came in, but that doesn't explain the differences in
treatment. It is a difficult question to answer."

Berdan cautioned that some of the differences noted in Latin
America and Eastern Europe may be due to a different approach
to large clinical trials in these regions. Since these regions
have many heart patients and haven't been involved in trials,
this population is ripe for future study, Berdan said.

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