Yan and colleagues raise an interesting point in regard to the apparent “treatment” effects of the American College of Cardiology GAP system in women compared with men. Because our study was observational in nature, we agree that it is possible that the apparent superior impact of the GAP discharge document in women was confounded by some other factor, either measured or unmeasured.1 However, we believe not only that the effect may be real but also that known biological differences in coronary heart disease pathophysiologic mechanisms and presentation can explain at least part of this observation.
Eagle KA, Montoye C, Riba A. Sex Differences in the Benefits of the Guidelines Applied in Practice Project: Are They Due to Sex?—Reply. Arch Intern Med. 2006;166(21):2406. doi:10.1001/archinte.166.21.2406