Sex inequalities in ischaemic heart disease in general practice: Cross sectional survey

Objective: To study differences in treatment for men and women with ischaemic heart disease by using standards defined in England's national service framework for coronary artery disease. Design: Cross sectional survey using routinely collected data. Setting: 18 practices in 18 primary care groups in Trent Region. Subjects: 5891 men and women aged over 35 years with a diagnosis of ischaemic heart disease or prescription for nitrates recorded on computer. Main outcome measure: Difference in the proportion of men and women with ischaemic heart disease and taking lipid lowering treatment. Results: Women were less likely than men to have a recording of body mass index (79% (2197/2783) v 82% (2552/3102), P = 0.002), smoking (86% (2386) v 89% (2779), P < 0.0001), and blood pressure (95% (2643) v 96% (2986), P = 0.04). Women were also less likely to have a recording of fasting cholesterol concentration (35% (968) v 50% (1550), P < 0.0001) but were more likely to be obese (25% (558/2197) v 20% (514/2552), P < 0.0001) and have their most recently recorded blood pressure value over the recommended 140/85 mm Hg (60% (1598/2643) v 52% (1553/2986), P < 0.0001). Although a higher proportion of women had a raised serum cholesterol concentration (77% (749/968) v 67% (1043/1550), P < 0.0001), men were more likely to take aspirin (76% (2358) v 71% (1979), P < 0.0001), have a recorded diagnosis of hyperlipidaemia (13% (418) v 10% (274), P < 0.0001), and be prescribed lipid lowering drugs (31% (973) v 21% (596), P < 0.0001). These differences remained despite adjustments for the practice where the patient is registered, age, smoking stares, obesity, diabetes, and hypertension. Conclusion: The results suggest a systematic bias towards men compared with women in terms of secondary prevention of ischaemic heart disease.