The challenge of women and heart disease

Do women and men experience different symptoms with acute coronary syndrome (ACS)? If differences exist, are they sufficient to warrant a different public health message? Should clinicians factor in sex when trying to diagnose ACS in the emergency department? Do other patient characteristics (such as age, race, or the presence of diabetes) significantly affect clinical presentation? These questions are important in an era when the American public has become increasingly aware that ACS is not a male disease and women proudly wear a pin shaped as a red dress to demonstrate their vulnerability to heart disease.1 Physicians have been sensitized to the potential of a missed diagnosis of ACS, often through personal experience with 1 or more female patients who delayed seeking treatment for hours or even days, thereby postponing life-saving treatment. On average, women experience a longer time interval than men between the onset o