Gendered Innovation in Cardiovascular Science: Implementation of Sex and Gender into Clinical and Biomedical Research

In many diseases male and female patients present with different symptoms. Frequently, however, no gender-sensitive diagnostics are performed and inappropriate therapeutic options may be offered. A better knowledge of gender differences in medicine could personalize treatment and increase quality of health care specifically in the area of diagnostics and consecutive treatment.[1] [2]

There is a certain amount of innovative gender-sensitive approaches in medicine including surgical specialties. In this regard, women experience gendered exposure to several risk factors such as pregnancies/reproductive history and related complications, which may play a major role and could lead to a specific onset of symptoms.[1] [2] [3] [4] [5]

Pregnancy is a multidimensional condition; previously healthy women may develop diseases during pregnancy, or women affected with disease get pregnant. In addition, maternal illness in pregnancy affects two patients, the mother and the fetus.[3] [4] [5] These conditions require even more distinct specialized treatments and can only be managed in a multidisciplinary approach. Disease management has to be optimized since optimal treatment for the mother may harm the fetus and vice versa.

Especially, studies for medical treatment of pregnant women are scarce since entering pregnant women into clinical trials is problematic for many ethical reasons. But ignoring the problem may be even more problematic since physicians are faced with a diagnostic and therapeutic dilemma, and may possibly prescribe drugs whose effects during pregnancy are poorly investigated.

To give a clinical example, the risk to develop coronary artery disease in women with autoimmune diseases, rheumatoid diseases, and preeclampsia is 50% (for each entity) during lifetime. If these patients receive a coronary angiogram, this is usually without pathological findings.[6] If they undergo a functional magnetic resonance imaging, one may find a microangiopathy and treat them in an appropriate manner as suggested in specific guidelines by European Society of Cardiology (ESC) and the American Heart Association.[6] In fact, for cardiovascular disease in pregnancy new guidelines have been published recently by the ESC and the European Society of Gynecology in cooperation with the Association for European Pediatric Cardiology and the German Society for Gender Medicine which provided support in this field.[3] [4]

Although only a small percentage of researchers is involving sex and gender considerations, clinical findings demand the necessity as demonstrated by the mortality rate of women after myocardial infarction. Independent of treatment option and improvement of therapies, mortality rates in women remain almost twice as high compared with men in the Western world.[6]

• References

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• 3 Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C , et al; European Society of Gynecology; Association for European Paediatric Cardiology; German Society for Gender Medicine; Authors/Task Force Members; ESC Committee for Practice Guidelines; Document Reviewers. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011; 32 (24) 3147-3197
• 4 Regitz-Zagrosek V, Seeland U, Geibel-Zehender A, Gohlke-Bärwolf C, Kruck I, Schaefer C. Cardiovascular diseases in pregnancy. Dtsch Arztebl Int 2011; 108 (16) 267-273
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