One study shows that, of 823 patients admitted for heart attacks, one-third of the women had died after six months compared with one- sixth of the men. Doctors from London and Nottingham, writing in tomorrow's British Medical Journal, say that sexism is at work.
They found women were less likely to be given clot- busting drugs in hospital, less likely to be treated in a specialist coronary care unit and less likely to be given protective drugs once discharged.
However, a third research paper, from Manchester, suggests that ageism rather than sexism may be the reason, as women are usually older than men when treated. Elderly heart attack patients of both sexes are less likely to be given the clot-busting drugs.
British women head the international league for heart disease deaths, the World Health Organisation reported in July, and also have the worst rates of heart disease among 21 nations studied.
In a leading article in the journal, Dr Graham Jackson, a cardiologist at Guy's Hospital, London, contends that 'an equal opportunity killer needs equal opportunity management'. Neither women nor doctors are well enough aware of the risks, he says.
Dr Jackson points out that before 65 heart disease is half as common in women as in men. It affects one in nine women aged 45 to 65. After 65 the rates level up. But it also affects pre-menopausal women - one-quarter of deaths from heart attack in women under 65 happen to women before their 45th birthday.
He said yesterday: 'If you ask women in the street what disease they are most at risk from they will say breast cancer. This is not true. Women are not aware of their risk of heart disease and doctors may not be aware of it either.'
Dr Jackson said women may delay getting help: 'If a man gets a chest pain he is likely to think about a heart attack. If a woman gets a chest pain she is likely to think she has a chest pain. This may be one reason why women tend to be older and to have more severe disease when treated.'
Dr Karen Clarke, of the Nottingham University cardio-vascular medicine department, says that in 1991 heart disease accounted for 82,000 deaths in men and 68,500 in women, while breast cancer killed 13,800 women. In an analysis of 2,723 patients admitted after heart attacks, 56 per cent of the men compared with 41 per cent of the women went to coronary care units. Women fared less well than men in all age groups in terms of specialised care, and women over 75 did worst of all.
Dr Clarke says: 'There is already enough evidence to suggest that women with chronic angina are less likely to receive surgical treatment, and we now have evidence that they are less likely to receive the best available treatment after myocardial infarction (heart attack).'