Gender Differences In Pathophysiology Research Articles

Myocardial Infarction in Systemic Lupus Erythematosus - the Sex-Specific Risk Profile.

Accelerated atherosclerosis is widely present in patients with systemic lupus erythematosus. The aim of this review was to analyze the relationship between systemic lupus erythematosus and cardiovascular diseases, with the emphasis on acute myocardial infarction. We conducted a literature review through PubMed and Cochrane, using keywords: SLE, atherosclerosis, atherothrombosis, coronary artery disease, myocardial infarction, prognosis, sex specifics. Various molecular mechanisms triggered by infection/inflammation are responsible for endothelial dysfunction and the development of atherosclerosis at an earlier age. A contributing factor is the cumulative effect of traditional cardiovascular risk factors interaction with disease-related characteristics. Myocardial infarction rates are 2- to 10-fold higher compared to the general population. Young women have the highest relative risk, however, men carry at least 3-fold higher risk than women. Coronary involvement varies from normal coronary artery with thrombosis, coronary microartery vasculitis, coronary arteritis, and coronary atherosclerosis. Typical clinical presentation is observed in men and older women, while atypical is more frequent in young women. Treatment is guided by the underlying mechanism, engaging invasive procedures alone, or accompanied with immunosuppressive and/or anti-inflammatory therapy. There are significant gender differences in pathophysiology and clinical presentation. However, they receive the same therapeutic treatments. Systemic lupus erythematosus is a major contributor to atherosclerotic and non-atherosclerotic mechanisms involved in the development of myocardial infarction, which should be taken into account during therapeutic treatment. Although systemic lupus erythematosus per se is a "female" disease, males are at increased cardiovascular risk and worse outcomes.

Gender differences in the association of syndecan-4 with myocardial infarction: The population-based Tromsø Study

Background and aimsCardiovascular disease is a common cause of morbidity and mortality, with gender differences in pathophysiology. The endothelial glycocalyx maintains vascular integrity, and glycocalyx shedding reflects endothelial dysfunction and early atherosclerosis. Syndecan-1 and -4 are components of the glycocalyx, and increased serum levels indicate glycocalyx damage. We hypothesised that increased serum syndecan-1 and -4 were independently associated with myocardial infarction (MI), ischaemic stroke and all-cause mortality in men and women from a general population. MethodsUsing a case-cohort design, we included 1495 participants from the Tromsø Study 2001-02. Syndecan-1 and -4 were measured in serum. Baseline variables also included age, gender, cardiovascular risk factors and urinary albumin-creatinine ratio (ACR). Hazard ratios were assessed using multivariable Cox regression models. ResultsBetween baseline in 2001-02 and December 2007 fatal or non-fatal MI was experienced by 328 and ischaemic stroke by 191 subjects, and 423 participants died. Syndecan-4 was independently associated with MI (hazard ratio per 10 ng/mL increase 1.32; 95% confidence interval 1.06–1.63), but not ischaemic stroke and mortality, and the associations were unchanged by adjustment for urinary ACR. Interaction between syndecan-4 and sex was borderline significant, and in gender-specific analysis, syndecan-4 was associated with MI in women only. Syndecan-1 was not associated with any endpoint. ConclusionsSyndecan-4 was associated with incident MI, and the association was stronger in women than in men. This suggests a link between endothelial glycocalyx shedding and coronary heart disease in women. Use of syndecan-4 as a risk marker in clinical setting needs further investigation.

Gender effects on auditory P300: A systematic review.

The evidence suggests that gender-related effects could influence the electrophysiological P300 parameters and stand as an additional source of variation for both clinical and non-clinical subjects. The aim of this paper is to characterize gender-related differences in P300 potential as elicited with simple auditory paradigms. This knowledge (1) is important for the practical assessment of P300 potential in normal and clinical populations, and (2) can provide an insight into the understanding of gender differences in pathophysiology, particularly those with differential risk or prevalence in males and females. With this review it is shown that a limited number of studies encounter possible gender effects on parameters of auditory P300, and the findings need to be read with caution due to methodological limitations of the studies. Nevertheless, evidence supports that the P300 amplitude could be significantly modulated by gender, with greater amplitude in females relative to males. Noteworthy, gender has a minimal effect on the P300 latency, and it is often comparable between males and females. Furthermore, the effect of gender on P300 could be modulated by hormonal background, anatomy and some methodological aspects.

Usefulness of Coronary Artery Calcium to Predict Heart Failure With Preserved Ejection Fraction in Men Versus Women (from the Multi-Ethnic Study of Atherosclerosis)

We studied the association of coronary artery calcium (CAC) and risk of heart failure with preserved ejection fraction (HFpEF) among men and women in a multiethnic cohort. Coronary artery disease is a risk factor for development of HFpEF and assessment of subclinical atherosclerosis using CAC may allow for the early identification of patients at risk for HFpEF. We used data from the Multi-Ethnic Study of Atherosclerosis. CAC was measured at baseline in all participants. Incident HFpEF was defined as heart failure hospitalization with left ventricular ejection fraction ≥50%. Multivariable-adjusted Cox proportional hazards models were used to calculate HFpEF risk by CAC categories (0, 1 to 100, 101 to 300, and >300) and by CAC (continuous), stratified by gender and race/ethnicity. Of 6809 total participants, 127 incident HFpEF cases (1.8%) were ascertained. Mean age was 62 years (±10 years), and the participants were 53% female, 38% White, and 12% Black. In adjusted analysis, CAC >300 was associated with increased risk of HFpEF (hazard ratio [HR] 1.68, 95% confidence interval [95 CI] 1.00, 1.83); however, this was significant only in women (HR 2.82, 95% CI 1.32, 6.00 vs HR 0.91, 95% CI 0.46, 1.82 for men, interaction p = 0.03). Similarly, CAC modeled as a continuous variable was strongly predictive in women but not in men. In conclusion, measurement of CAC, a marker of coronary atherosclerosis, may stratify risk of HFpEF beyond traditional risk factors for women. Further investigation is needed to better understand potential gender differences in pathophysiology and presentation of HFpEF.

Metabolic Syndrome: Does it Differ Between Women and Men?

Cardiovascular disease represents a massive healthcare burden worldwide. Gender differences in the pathophysiology, presentation and prognosis of cardiovascular disease have been described in the literature. Metabolic syndrome, characterized by a cluster of metabolic abnormalities is associated with increased risk for type 2 diabetes mellitus and atherosclerotic cardiovascular disease. With the global obesity epidemic, the prevalence of metabolic syndrome is rising rapidly in the developed as well as developing world. However, there is considerable variation in the prevalence based on geography, age, sex and, definition used for diagnosis. Data on gender related differences in metabolic syndrome is relatively scarce. Here, we aim to review the gender differences in epidemiology and pathophysiology of metabolic syndrome as well as its individual components. Knowledge of gender differences in metabolic syndrome can help design gender specific preventative and therapeutic strategies that will have a positive impact on overall population health.

Gender in atrial fibrillation: Ten years later

Atrial fibrillation (AF) is the most common arrhythmia encountered in both male and female patients. This evidence-based update attempts to address the advances in the science of AF management in light of key gender issues. In October 2009, 2 investigators (H.I.M. and B.D.P.) independently searched MEDLINE (PubMed [1950-2009] and Ovid [2000-2009]) for all publication types in the English language, using database-specific controlled vocabulary describing the concepts of AF and gender (atrial fibrillation, gender, women, and men for PubMed; atrial fibrillation and gender for Ovid). The reference sections from the identified publications were also used. The methodologic quality of publications, their content relevance, and the authors' expert opinions guided publication inclusion in this evidence-based narrative review. Articles relevant to gender differences in pathophysiology, outcomes, and treatment of AF are summarized and discussed. Based on current available data, mortality is greater for women with AF than for men with AF. Women with AF have a higher risk of stroke compared with their male counterparts. Women derive the greatest benefit from anticoagulation in AF. There are no significant sex differences in major bleeding risk from warfarin. Women tend to be more symptomatic from AF than are men, but fare worse than men when a rhythm-control strategy is utilized with antiarrhythmic medications. Women have an increased risk for torsades de pointes when taking sotalol or dofetilide, and have a higher risk of bradyarrhythmias when taking antiarrhythmics. AF catheter ablation is successful and beneficial for selected patients of both sexes, although women may incur higher procedural bleeding complications. Women tend to be referred for AF ablation less and later than are men. The past decade has witnessed significant progress in the understanding and management of AF. Awareness of key sex-specific differences in AF allows for a more safe, effective, and personalized approach to the management of this disorder.

Women's Ischemic Syndrome Evaluation: current status and future research directions: report of the National Heart, Lung and Blood Institute workshop: October 2-4, 2002: Section 6: key messages about acute ischemic heart disease in women and recommendations for practice.

Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUB

Hypertension in women.

Hypertension is an important risk factor for cardiovascular disease in women. Although younger, premenopausal women have lower blood pressures than age-matched men, population blood pressure rises with age, and the prevalence of hypertension is higher in older women. Oral contraceptive use increases the risk of hypertension in women, and women using this therapy should have blood pressure monitored twice yearly. The risk of hypertension is low in normotensive women receiving HRT. Few studies of HRT in hypertensive women have been performed, and more information is needed to assess the risk of worsening hypertension in hypertensive postmenopausal receiving this therapy. Investigations of gender differences in pathophysiology and response to treatment of essential hypertension have not been extensive, and current evidence does not support gender-specific treatment of hypertension at the present time.