Sex, gender and cardiovascular disease

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.

WEBSITE: http://www.secardiologia.es/actualidad/entrevistas/3807-sexo-genero-enfermedades-cardiovasculares

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.