Date of Award

Fall 2011

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Clinical Health Sciences (Health Research Methodology)


Sonia Anand


Mita Giacomini, Harry Shannon



Committee Member

Mita Giacomini, Harry Shannon


There has been much controversy in the cardiovascular literature regarding sex/gender differences in the presentation of coronary artery disease and downstream implications. The aim of this thesis is not to resolve this controversy, but rather to assess and critique potential sex/gender similarities and differences from a variety of perspectives, explored through various methodologies.

This thesis contains four main studies, each employing different quantitative and qualitative methods. An overarching framework was developed to contextualise each study presented in this thesis. The first main study entitled, the “RACE CAR” trial assessed physician opinion prospectively observing that women are perceived to benefit less from cardiac catheterization compared to men, while controlling for age, TIMI risk and preference for cardiac catheterization. The “Identifying women with severe angiographic coronary disease” study observed physician referral patterns retrospectively and determined that although women are less likely to have severe angiographic disease compared to men, the traditional risk factors and CCS Class IV angina are significant predictors of severe angiographic disease. This is an important finding to help physicians better identify women at risk.

The findings from these two studies identified the need for the cardiovascular research community to better define angina, particularly among women. Using qualitative methodology, a new theory of angina emerged, illustrating symptoms along a gender continuum. Based on the findings from the qualitative study, the final study of this thesis developed an assessment tool to test the symptom parameters along the gender continuum. The findings confirm that the symptoms of women and men represent more shared experiences rather than differences, particularly among patients with obstructive coronary artery disease.

These studies collectively address knowledge gaps and add new information to various stages of patient cardiac care within the sex/gender programme of cardiovascular research.

McMaster University Library