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Research turns up surprise on coronaries

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Women are just as likely as men to survive heart attacks, even though they typically are treated somewhat less aggressively, a study found.

Many studies in recent years have documented that men are more likely than women to get state-of-the-art treatment for their heart attacks. But those studies generally did not answer whether the extra treatment makes a difference.

The new research determined that men are slightly more likely to get most — though not all — necessary drugs. But in the end this does not seem to give men a significantly better chance of surviving, at least for the first month after their heart attacks.

Although the results are encouraging, the gender differences are still a concern, said Dr. Leighton Chan of the University of Washington School of Medicine, one of the researchers.

"I wouldn't necessarily say the issue is a dead one," Chan said. "I think our study still supports the fact that early identification of a heart attack in women is probably not done as well as it is in men."

Heart attacks are the leading cause of death for both men and women, although Chan noted, "We think of the 55-year-old overweight guy who has been eating cheeseburgers who clutches his heart."

Other research has shown that doctors may miss heart attacks in women for a variety of reasons. For one thing, women are less likely to suffer crushing chest pain.

The latest study, published in Thursday's New England Journal of Medicine, looked at 138,956 Medicare patients who had heart attacks in 1994 or 1995. Unlike previous studies, this one screened out patients for whom the treatments were not considered appropriate.

The women studied were significantly older than the men, were more likely to wait to seek treatment and also waited longer for an electrocardiogram once they arrived at the hospital.

Among other findings:

Women were 7 percent less likely than men to receive clot-dissolving drugs within the first hour of treatment and 3 percent less likely to get the drugs during their hospital stay.

Women were 6 percent less likely to get aspirin within the first day in the hospital.

Women had fewer catheterizations to determine whether they needed angioplasty or a heart bypass to clear blocked arteries, and that disparity increased with age.

For two standard heart attack medicines, women received the same or slightly better treatment than men. They were as likely as men to be prescribed beta blocker drugs, which reduce the heart's workload, and 5 percent more likely to get ACE inhibitors.

Dr. Nanette K. Wenger of the Emory University School of Medicine noted that previous studies have shown major differences in treatment and outcome for men and women.

"I find this encouraging. It seems that physicians treating the Medicare population across the country are getting the message," Wenger said.

One surprise in the study was that women were 26 percent more likely to have do-not-resuscitate orders stipulating that no extraordinary measures be used to prolong their lives. Chan could not explain this difference.