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GPC refuses 'essential' guide

Sharp inequalities emerge in cardiovascular treatment with women and the less affluent missing out – by Rob Finch

GPs are treating women less rigorously than men for cardiovascular disease and the gender gap may be widening, according to a new study.

The authors claimed GPs had a 'cultural problem', after finding women received fewer investigations, drugs and referrals for surgery than men with the same condition.

The study, presented at the recent peer-reviewed Society for Academic Primary Care conference in Glasgow, found inequalities in care were as sharp as in the mid-1990s, despite more intensive management of heart disease.

Researchers updated an initial 1995 study of angina patients at eight practices in Liverpool. They analysed the notes of 1,158 patients treated during 2001 at the practices, which served a mixture of

affluent and deprived areas.

The study found evidence the gender gap was widening, with men 90 per cent more likely to have their cholesterol measured and 88 per cent more likely to be prescribed ß-blockers for secondary prevention.

The gap also grew for referrals for coronary revascularisation, although it narrowed for aspirin prescribing and referrals for exercise ECGs.

Study leader Dr Mike Crilly, senior lecturer in clinical epidemiology at the University of Aberdeen, said: 'Men are far more likely to be intensively investigated and managed than women.

'Even when women have had a heart attack, this doesn't change. And despite some things improving, they are still falling behind.'

Dr Crilly, a former GP, said it was dangerous to presume the new national service framework would benefit the genders equally. He added: 'I think it's professionally a cultural problem that women's heart disease is seen as less serious than that of men.'

But he also claimed patients' own beliefs could exacerbate the problem, arguing men were often 'dragged to the doctor' by their partners.

Merseyside GP Dr Anthony Cummins, clinical director of the Wallasey Heart Centre, said: 'It doesn't surprise me because traditionally coronary heart disease has been seen as a man's disease.'

He admitted there might be a subconscious sexism within the profession, saying GPs were often guilty of 'sins of omission' by failing to act on information they received.

lSimvastatin 10mg finally went on sale in high street pharmacies last Thursday, after a snap announcement from manufacturer Johnson & Johnson.

Around 7.4 million people at moderate risk of CHD will be eligible to buy the drug, according to the company.

Recent legal changes mean simvastatin can be advertised directly to consumers. It will be sold as Zocor Heart-Pro, at £12.99 per 28-tablet pack.

...risks for less affluent underestimated too

Less affluent patients are missing out on preventive treatment for cardiovascular disease because assessment charts underestimate their risk, research concludes.

The authors have suggested applying a 'postcode factor' to the Framingham scores, which will continue to provide the basis for the Joint British Societies guidelines when they are updated later this year.

The study, submitted to the BMJ, applied Framingham scores to a population in the west of Scotland and found 93 per cent of patients who died from cardiovascular disease in deprived areas had been classified as 'low risk'.

Researchers analysed data from 15,000 patients followed up since 1972, finding risk was underestimated in 48 per cent of manual workers and 31 per cent of non-manual workers.

Study leader Dr Peter Brindle, Wellcome training fellow in health services research at the University of Bristol and a GP in the city, said: 'The accuracy of Framingham tends to depend upon background risk and this study was done in a very high-risk population.'

Dr Brindle criticised the forthcoming Joint British Societies guidelines, which will lower thresholds for secondary prevention of CVD. He said: 'If you lower the threshold you'll pick up more people and you'll also get more false positives, but the proportion of deprived people reaching the threshold will remain the same.'

But Professor Paul Durrington, professor of medicine at Manchester Royal Infirmary and a member of the guidelines committee, said Framingham remained the most appropriate system to assess risk.

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