Gender bias in the clinical management of women with angina: Another look at the Yentl syndrome

Michael A. Crilly, Peter E. Bundred, Lisa C. Leckey, Fiona C. Johnstone

Research output: Contribution to journalArticle

18 Citations (Scopus)


Background: Woman with heart disease may receive lower levels of clinical care than men. We assessed whether the Yentl syndrome (women receive equivalent care to men only when they demonstrate that they are like men by having a heart attack) operates in the management of angina pectoris in primary care.

Methods: The study design is a cross-sectional survey of 1162 angina patients (552 women) managed in eight sentinel centers serving 15% of the population of Liverpool. Data were extracted by specially trained data managers. Analysis included directly age-standardized proportions and male/female adjusted odds ratios (AOR), adjusted for age, disease duration, physician consultation rate, and age at diagnosis.

Results: All aspects of care were higher for men with angina-previous myocardial infarction (MI) than for women with angina-previous MI. Risk factor recording was an absolute 8% higher (95% CI 1%-17%), secondary prevention 9% higher (95% CI 1%-17%), cardiac investigation 10% higher (95% CI 1%-20%), and revascularization 13% higher (95% CI 4%-22%). Men with angina-previous MI consistently received the highest level and women with angina the lowest level of risk factor recording (AOR 1.79, 95% CI 1.21-2.66), secondary prevention (AOR 2.24, 95% CI 1.47-3.40), cardiac investigation (AOR 2.21, 95% CI 1.56-3.13), and revascularization (AOR 4.67, 95% CI 3.03-7.18). The provision of care to men with angina alone and women with angina-previous MI fell between these two extremes.

Conclusions: A gender-based clinical hierarchy operates in the clinical management of angina pectoris in primary care. The Yentl syndrome did not apply, however, as women with angina received less intensive clinical care than similar men irrespective of prior MI.

Original languageEnglish
Pages (from-to)331-342
Number of pages12
JournalJournal of Women's Health
Issue number3
Early online date29 Mar 2008
Publication statusPublished - Apr 2008


  • coronary-heart-disease
  • cross-sectional survey
  • primary-care
  • stable angina
  • myocardial-infarction
  • general-practice
  • artery-disease
  • chest pain
  • sex bias
  • inequalities


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