Korean Circ J.  2018 Sep;48(9):792-812. 10.4070/kcj.2018.0249.

Unsettled Issues and Future Directions for Research on Cardiovascular Diseases in Women

• Regitz-Zagrosek V

• KMID: 2418805
• DOI: http://doi.org/10.4070/kcj.2018.0249

Abstract

Biological sex (being female or male) significantly influences the course of disease. This simple fact must be considered in all cardiovascular diagnosis and therapy. However, major gaps in knowledge about and awareness of cardiovascular disease in women still impede the implementation of sex-specific strategies. Among the gaps are a lack of understanding of the pathophysiology of women-biased coronary artery disease syndromes (spasms, dissections, Takotsubo syndrome), sex differences in cardiomyopathies and heart failure, a higher prevalence of cardiomyopathies with sarcomeric mutations in men, a higher prevalence of heart failure with preserved ejection fraction in women, and sex-specific disease mechanisms, as well as sex differences in sudden cardiac arrest and long QT syndrome. Basic research strategies must do more to include female-specific aspects of disease such as the genetic imbalance of 2 versus one X chromosome and the effects of sex hormones. Drug therapy in women also needs more attention. Furthermore, pregnancy-associated cardiovascular disease must be considered a potential risk factor in women, including pregnancy-related coronary artery dissection, preeclampsia, and peripartum cardiomyopathy. Finally, the sociocultural dimension of gender should be included in research efforts. The organization of gender medicine must be established as a cross-sectional discipline but also as a centered structure with its own research resources, methods, and questions.

Keyword

Women; CVD; Gender; CAD; HF

MeSH Terms

Cardiomyopathies
Cardiovascular Diseases*
Coronary Artery Disease
Coronary Vessels
Death, Sudden, Cardiac
Diagnosis
Drug Therapy
Female
Gonadal Steroid Hormones
Heart Failure
Humans
Long QT Syndrome
Male
Peripartum Period
Pre-Eclampsia
Prevalence
Risk Factors
Sex Characteristics
X Chromosome
Gonadal Steroid Hormones

Figure

• 

  Figure 1 Complex interdependency of sex and gender in humans (reprinted with permission from Sex and gender aspects in clinical medicine, edited by Oertelt Prigione and Regitz-Zagrosek, Springer, 2011).1)

• 

  Figure 2 Gender is needed as a cross-sectional element in all disciplines. However, major scientific achievements can only be expected if the discipline also develops its own scientific aims, hypotheses, and methods that can then be exported to other disciplines. This needs an own institute.

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