Author + information
- Louise Pilote, MD, MPH, PhD∗ ()
- ↵∗Division of General Internal Medicine, McGill University Health Centre, 1001 Decarie Boulevard, Room D05.5021, Montreal, Quebec H4A 3J1, Canada
Drs. Paulus and Kent bring up the concept of index event bias (IEB) in potentially explaining the association between gender and recurrent acute coronary syndrome (ACS). In our study the possible effect of IEB is unlikely given that a feminine gender was also associated with risk factors for ACS (1). Therefore, the effect of gender was in the same direction both for the index and the recurrent event.
We found that gender characteristics traditionally ascribed to women, such as home responsibilities and caring attributes, were related to a higher risk of recurrent ACS. We constructed a novel gender score to assess this association (1). The message to draw from our study is not that patients should adopt a more masculine gender but that patient and provider should recognize that roles and traits traditionally ascribed to women are associated with outcome independent of sex. For example, a person with demanding household responsibilities including caring for children may be less likely to adhere to treatment or may have difficulty managing disease and thus be at higher risk of a recurrent event.
Preventing recurrent events is of tantamount importance given that an acute event often represents the first opportunity for risk reduction. The possibility of IEB should not be a deterrent as the association between gender, risk factors, and recurrent events is not a paradox.
Please note: Dr. Pilote has reported that she has no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation