Is what's good for the gander good for the goose?

Abstract

Editorial Note: The gender initiative, a provocative series on gender differences in the surgical treatment of cardiac, vascular, and thoracic disease, continues this month with editorials on coronary revascularization in women. A foremost expert in gender-specific risks and outcomes, Nanette K. Wenger, MD, summarizes the best available data, progress to date, and remaining questions for women undergoing coronary revascularization. Another group summarizes the statistical problems that may confound studies of gender differences. Finally, cardiac surgeons contemplate possible differences in the technical aspects of coronary artery bypass grafting. The series continues in December with editorials on coronary artery surgery and recovery. Nancy A. Nussmeier, MD Texas Heart Institute See related editorials on pages 932, 936, 950, and 959. C oronary heart disease is the leading cause of death for women in the United States, accounting for almost 250,000 deaths annually. Since 1984 more US women than men have died each year of cardiovascular disease. Emerging data have reinforced sex-related differences in responses to therapies, including adverse responses. This editorial highlights the excess mortality of coronary artery bypass graft (CABG) surgery in women, addressing the need to derive more detailed sex-specific information that has the potential to improve clinical outcomes. Owing to the paucity of randomized trial data for women, the material presented derives primarily from databases, registries, and case series.