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MARKS, MD: And an angiogram is a dye study to look at the coronary blood vessels
BENJAMIN LEWIS, MD: That's correct. It's an invasive test. It actually puts a tube into the arteries of the heart and shoots dye into it and we can see them directly
MARIANNE LEGATO, MD: An interesting unsolved question is why physicians consistently -- except in tertiary care centers like Columbia, the Mayo Clinic, and so on --
DAVID R. MARKS, MD: What's a tertiary care center?
MARIANNE LEGATO, MD: It's the most sophisticated center, where people who are really, really ill are preferentially referred, and it's usually where the biggest volume of procedures are done, as Mehmet and Ben can tell you. The fact is, though, that there is a tendency, for women, to be offered and have more conservative treatment than aggressive treatment, like angioplasty and coronary artery bypass surgery
DAVID R. MARKS, MD: Angioplasty is the balloon that opens up the vessel?
MARIANNE LEGATO, MD: Exactly. There's a laser that opens up the vessel. The reason for that isn't clear. Do physicians want to protect women from these more invasive procedures? That's one possibility. The other is that women themselves may be reluctant to agree, if they're offered a choice between conservative and aggressive treatment, to the more aggressive treatment. But the fact is that there is a disparity in the aggressiveness with which doctors offer women treatment for coronary disease, except, as I said, in the most sophisticated centers, where that tends to not be an issue
DAVID R. MARKS, MD: Are there some medications that work in men and don't work in women?
BENJAMIN LEWIS, MD: I was going to address the point of medication therapy. I think that we're finding out more about how women respond to medicines that men have been exposed to. Again, part of the problem with studying women has been the concern that to give a premenopausal woman a drug therapy or a surgical therapy or an invasive test, or even a radiation-based imaging study, that you're putting them at risk as well as the possibility that if they're pregnant they would be at risk for the child. So some of the data that we would like to know I think is going to be developed
What I think is more important, from my perspective as a non-surgeon, is the fact that we are not aggressive enough in identifying women earlier. If we think that there's going to be a problem in terms of how they respond to the advanced techniques of angiograms and surgery, then we should really be addressing preventive care much more aggressively. We should be highlighting that the things that contribute to it -- in particular, smoking -- the big concern I have now is that I understand the group that's growing for cigarette smoking use is adolescent women, adolescent girls, and I think this is going to potentially undermine our efforts to keep them well as they get older
MARIANNE LEGATO, MD: I think that's a terribly important point. I think the American Heart has pointed out that most of the gains that we're going to make in the treatment, even the most aggressive treatment, of coronary disease have been made, and the real strides are going to be made, as Ben said, in prevention and lifestyle changes. I think that's where the real gold mine will prove to be
DAVID R. MARKS, MD: That'll be the last word. Thank you for joining us. And thank you for joining our webcast. I'm Dr. David Marks. Goodbye
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