Married women find it harder than men to make essential lifestyle changes following a heart attack - because their husbands refuse to help.
While men are often supported by their wives as they adjust their diet and habits after a heart attack, women cannot rely on their husbands to do the same for them.
As a result, women may be left more at risk of a second heart attack, a study has found.
Stephen Wright, of Leicester General Hospital, Alan Radley of Loughborough University and Herbert Thurston of Leicester University, interviewed 60 men and 60 women six months after they were discharged from hospital after a first heart attack.
Patients were asked whether they had suffered any problems since the attack. The research, funded by the NHS research and development programme, found more women than men reported problems.
Men were found to face difficulties at work, while women noted more problems related to their health in general. These results, says Dr Wright, may be because women on average have heart attacks 15 years later than men, when they no longer work and are suffering the effects of age.
But what is more significant, he says, is the fact that two and a half times as many men as women reported no problems and twice as many women as men reported problems related to making lifestyle changes.
One woman cut down her smoking from 40 to 15 cigarettes a day, but found making dietary changes far more difficult, particularly as her husband refused to join her, leaving her to cook two meals.
Dr Wright said: "If you compare single men and married men who are expected to make changes, it appears that married men may be more likely to change because their wives will help and encourage them to do so.
"I suspect it is largely the other way around with women who have had a heart attack. Married women may be less likely to take on the changes because they have to look after their husbands."
Research shows women are less likely to attend cardio rehabilitation classes and more likely to drop out once they have started.
Dr Wright added: "Heart attacks are seen very much as a men's disease. But if you look at mortality and the main cause of death in women, heart disease is quite a long way ahead of other diseases. Cardiovascular problems kill more than all cancers put together. These findings call for the inclusion of women's issues and concerns in planning cardiac rehabilitation programmes.
"Until now people have argued that because women are on average older when they have a heart attack they report more problems. But it is not just a function of age."
The researchers examined the relationship between age and reported problems in the women. They found a clear but negative relationship. Older women reported fewer problems. There was no relationship in men between age and reported problems.
Dr Wright said: "Older women perhaps have fewer other people to care for and can therefore more easily change their own lives."