Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes

In the vast majority of cardiovascular diseases (CVDs), there are well-described differences between women and men in epidemiology, pathophysiology, clinical manifestations, effects of therapy, and outcomes. These differences arise on one hand from biological differences among women and men, which are called sex differences. They are due to differences in gene expression from the sex chromosomes and subsequent differences in sexual hormones leading to differences in gene expression and function in the CV system, e.g. in vascular function and NO signalling, in myocardial remodelling under stress, or metabolism of drugs by sex-specific cytochrome expression. Sex differences are frequently reproducible in animal models. In contrast, gender differences are unique to the human. They arise from sociocultural processes, such as different behaviours of women and men; exposure to specific influences of the environment; different forms of nutrition, lifestyle, or stress; or attitudes towards treatments and prevention. These are equally important for CVDs.

In its current research framework programme ‘Horizon 2020’, the EU calls for the inclusion of the gender dimension into biomedical research since ‘it helps improve the scientific quality and societal relevance of the produced knowledge, technology and/or innovation’ (http://ec.europa.eu/programmes/horizon2020/en/h2020-section/promoting-ge...).