Dallas -- Women with heart trouble are treated less aggressively than men because they often are too old or ill for risky procedures, not because of sex bias, suggest two studies released yesterday.
However, two other studies came to opposite conclusions: Even when they are the same age and condition as male heart victims, women are less likely to receive the most up-to-date care.
Statistics clearly show women are treated less aggressively for heart problems. The question is why. And the conflicting results of the latest round of studies demonstrate the difficulty in sorting this out.
The subject received prominent attention at the annual meeting of the American College of Cardiology, which began yesterday.
Among those who believe sex bias is a factor is Dr. Bernadine Healy, a cardiologist who heads the National Institutes of Health. She called it the "Yentl syndrome," a reference to Isaac Bashevis Singer's short story about a young woman who had to disguise herself as a man to study the Talmud.
Women are less likely than men to receive one of the most lTC important heart tests -- the angiogram. These X-ray movies, taken by releasing dye into the heart, are used to determine whether blockages in arteries need to be fixed. When serious blockages are found, people often undergo angioplasty, which uses a balloon to clear the arteries, or coronary bypass operations. Women are less likely to receive either of these treatments.
However, people who are older or have severe heart disease or complications are also less likely to have these demanding tests and procedures. All the studies asked whether factors of age and complications could explain the differences between men and women.
Women who suffer their first heart attack are typically 10 years older than men.
"It's a truly complex issue," said Dr. Bernard J. Gersh of the Mayo Clinic, co-author of one of the studies. "We are not ready yet to make an indictment."
Among the studies presented:
* Dr. Vivek K. Varma and colleagues from the University of Alabama reviewed the records of 1,012 men and women hos
pitalized with heart attacks. While the women received fewer procedures, the difference could be explained entirely by their greater age, more severe heart disease and complications such as diabetes and high blood pressure.
"We found no difference between men and women," Dr. Varma said.
* A similar but larger study, conducted by Dr. John B. Kostis of Robert Wood Johnson Medical School in New Brunswick, N.J., reviewed 42,595 heart attack victims in New Jersey over a two-year period.
While complications and age were important factors, he found that when these were taken into account, men were still about 25 percent more likely to be given high-tech procedures.
* Dr. Malcolm R. Bell and others from the Mayo Clinic reviewed the records of 22,378 men and women who had angiograms at the hospital over 10 years. While men were more likely to be referred afterward for angioplasty or bypass surgery, these differences disappeared when doctors took age and severity of illness into account.
* Dr. Douglas Miller and colleagues from St. Louis University Medical Center studied 481 patients to see whether women seen for suspected heart disease were as apt as men to be given more elaborate tests, such as angiograms. They found that men were twice as likely to get a follow-up test.
"It appears that there is a bias against women getting aggressive early care," said Dr. Miller. "The difference plays out a few years down the line when they start to get heart attacks. When they finally get into the medical care system, they are sicker and have more problems."