Cardiac Symptoms in Women and Men

To the Editor The study by Kreatsoulas et al¹ titled “Reconstructing Angina: Cardiac Symptoms Are the Same in Women and Men” is a valuable contribution to the published literature on sex differences in symptoms of ischemic heart disease; however, we believe that the title is misleading. Although the population studied had stable angina, the conclusion could be misconstrued as also applying to those with unstable disease (ie, acute coronary syndrome [ACS]); a population that requires urgent evaluation and often delays seeking treatment. It is critical to note that the findings from this study apply only to those with stable obstructive epicardial coronary artery disease (CAD) and differ markedly from previous studies of sex differences in symptoms of ACS. Study findings also differ from those recently reported by Tamura et al,² who reported pronounced sex differences in non–chest pain symptoms following 60-second balloon occlusion of the coronary artery during percutaneous coronary intervention in individuals with known CAD.² Shaw et al³ demonstrated that women had lower rates of obstructive CAD with both stable angina (odds ratio, 0.34; P < .001) and ACS (odds ratio, 0.47; P < .001).³