Bypassing women.

In comparison to men, women have it good when it comes to heart disease -- they have less of it. But when it comes to treating coronary atherosclerosis, they have it bad -- more women die during bypass surgery, a common treatment for severe atherosclerosis, than men.

Delos M. cosgrove and his colleagues at the Cleveland Clinic think the problem is that women are generally smaller than men.

Of 7,105 patients who had bypass surgery at the Cleveland Clinic between 1980 and 1982, 0.5 percent of the men died, compared with 1.7 percent of the women. Eight other studies have found a combined mortality rate of 1.7 percent for men and 4 percent for women, he says.

Analyzing 4,452 patients, Cosgrove found the key factor was body surface area. "It's not sex that's a problem," he says. "It's size." A small man would have the same prognosis as a small woman when compared with a larger man or woman.

One factor may be the vessel used for grafting, Cosgrove suggests. While the bypass procedure as originally designed used a large vein from the leg, many surgeons now believe an artery from the chest makes a better graft. But the artery is smaller than the vein, making the procedure more difficult, especially in smaller individuals, Cosgrove says.