Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
There are inequalities between men and women. It is no surprise that
some specific differences in behaviour are found when they also suffer
Ischaemic heart disease.
The question for me (after Aristotle on Equity) is which are..
a) real differences which OUGHT to be dealt wih differently,
or
b) inappropriate differences of attitude/response which OUGHT NOT to
result in different treatment.
in Category a) I note
1) Women get IHD on average 10-20 years later than men
2)in an Age cohort of IHD it is usual to find only 10-20% are Women
3) Women have higher cholesterol than men on average, but HDL averages
1.2mmol/l in women, compared an average HDL of 1mmol/l in men)
4) the 4S and other studies showed substantial differences in response
between men and women. Marginally more women died in the treatment group,
than the control group, for instance.
These legitimate differences can be allowed by using an LDL measure
and a target LDL of < 3mmol/l as a better target than the current
National Service Framework suggestion based on total cholesterol (which
as stated is complex, confusing, and very badly worded) before further
audit of medical responses.
I work in a group practice and like others have thought long and hard why women seem to do less well than men with IHD. We are heavily computerised and operate with protocols and templates.
Each month doctors are circulated lists of patients with cholesterol/ LDL levels above targets. We are a mixed partnership with 2 women and 3 men. We all have similar results, ie women have cholesterol levels higher than men.
This does not seem to be discrimination. Patients are called for and attend, but women especially often have their own agenda and do not see cholesterol management as high priority. They also seem more likely to report problems with prescribed medication and so compliance is less.
I suspect this problem is much more complicated than previously thought and differences between patient perceptions must be taken into consideration in determining future management.
discriminators, right and wrong..
There are inequalities between men and women. It is no surprise that
some specific differences in behaviour are found when they also suffer
Ischaemic heart disease.
The question for me (after Aristotle on Equity) is which are..
a) real differences which OUGHT to be dealt wih differently,
or
b) inappropriate differences of attitude/response which OUGHT NOT to
result in different treatment.
in Category a) I note
1) Women get IHD on average 10-20 years later than men
2)in an Age cohort of IHD it is usual to find only 10-20% are Women
3) Women have higher cholesterol than men on average, but HDL averages
1.2mmol/l in women, compared an average HDL of 1mmol/l in men)
4) the 4S and other studies showed substantial differences in response
between men and women. Marginally more women died in the treatment group,
than the control group, for instance.
These legitimate differences can be allowed by using an LDL measure
and a target LDL of < 3mmol/l as a better target than the current
National Service Framework suggestion based on total cholesterol (which
as stated is complex, confusing, and very badly worded) before further
audit of medical responses.
Competing interests: No competing interests