The
doctors María Jesús Salvador Taboada (MJST) and Milagros Pedreira Pérez (MPP)
respond to many questions related to the investigation about the better
prevention of gender, diagnosis and treatment of cardiovascular disease and
relevant factor in the progress of patient therapy.
1.- What is the basis to talk about the
gender differences related to disease?
MJST : Nowadays, the gender medicine is characterized by a
comparison between men and women with the inclusion of gender as a
sociocultural process within the medical hypothesis. This includes recognition
of the biological differences between men and women that go beyond sex. Of
course, different concentrations of sex hormones or the different expressions
of chromosomes X and Y, or the high percentage of fat in females are examples
of gender differences. However, there are syndromes that correlate equally to
both sex with a hormone profile or gene expression very close between both
genders.
2.- In what aspects should focus the
investigation studies?
MJST: The gender medicine requires a broad understanding
of the pathophysiological differences between men and women that can be
extrapolated from animal models or cells cultures. It’s important to know the
phenotype of gender-specific traits, because they can have an influence on
diseases as myocardial infarction, arrhythmias and immune syndromes.
Moreover, clinical research reveals
large differences in the clinical manifestations, presentation and results,
that are determined by gender, body mass composition and function, as other
gender-related characteristics. The gender can be affected by external agents
as stress, environment, workload, diet and lifestyle.
But the interaction between sex and
gender is difficult to identify and elucidate. For example, myocardial
infarction pain is explained differently between men and women, and it’s
unknown the biological profile of the pain or its perception in the genus
appear to have a role. Although there is an open research line, the road ahead
is long.
3.- In Spain, Are there differences in
the prevention, diagnosis and treatment?
MPP: In Spain,
as in other Western countries with similar socioeconomic, cultural and
educational differences were detected in all areas. In records made by the
Spanish Society of Cardiology, through its various sections and working groups,
we identified differences in the approach in the area of prevention, such as
the control and treatment of hypertension with increased use of diuretics
compared with the male or the least successful in maintaining proper weight and
physical activity. In women after age 50, there is a higher prevalence of
overweight, obesity and sedentary lifestyle, without forgetting that in the young
women group (under 55 years) smoking persists greater than in other groups
older ages and in men of all ages, as declining appreciated in the results
observed in the last EUROASPIRE.
We also identified differences in
diagnosis, in some cases attributable to different or peculiar clinical
manifestations, such as dyspnea in myocardial infarction as the main manifestation,
which can hinder a diagnosis, and therefore, delay prompt treatment and
consequent prognostic implications. Some records show less use of drugs of
proven effectiveness and diagnostic and therapeutic procedures as coronary
angiography and percutaneous interventions.
4.- What is the prognosis in the short
and long-term of cardiovascular disease in men and women?
MPP: Regarding the prognosis should be noted that overall
myocardial infarction in women appears about 10 years later and with greater
presence of risk factors as diabetes, and hypertension and heart failure,
conditions in the acute phase are to contribute to increased mortality.
There is some controversy about
increased mortality in acute myocardial infarction in relation to age and sex,
but it seems confirmed that this is higher in women for any age. Long term sex
loses strength as a marker of poor prognosis and would be other risk factors
and co-morbidities that determine the long-term survival.
5.- What do recommend reading about it?
MJST: A recently published “Sex and Gender Aspects in Clinical Medicine”, by Drs Sabine
Oertelt-Prigione and Vera Regitz-Zagrosek, published by Springer. This is the
first book on gender medicine that covers the field in a brief and complete,
covering a wide spectrum of disciplines and offers friendly messages to
remember in each chapter.
MPP: First, I would also recommend reading this book, for
its approach in the light of current knowledge related to the various sex and
gender differences in full in multiple areas, and that is a great help for any
professional medicine.
Also, for anyone interested in the
topic, we highly recommend the work of Dr. Carme Valls Llobet, who has studied
in depth the issue of differences between men and women in the world of
medicine. The book “Mujeres invisibles” is a good example of his career.
opinion column
Lucia
Retamales: In my opinion this is a good interview, because both doctors are
specialists in the field of cardiovascular disease. They have studies and clinical
experience in this area. The interview gives us information about this
important issue taking into account factors as gender for better prevention,
diagnosis and treatment of these diseases, in addition to the known and studied
risk factors as diabetes.
Rodrigo Iglesias: I think it's very important to consider the gender for medical diagnosis, because there are many men and women differences now. If we know these differences, we could provide better prevention, diagnosis and treatment of cardiovascular diseases
Lylianne: Differences
in cardiovascular
risk factors between men and women
should not be significant between each
other, as sex is independent
risk factor, even when it is said
that they are genetically
predisposed man by
estrogenic intrinsic factor women, but still
always associated cardiovascular risk to the quality of life of people as sex itself.
