A Scientific Imperative as Seen Through a Sharpened Lens: Sex, Gender, and the Cardiovascular Condition

Bello, Natalie A.; Merz, C. Noel Bairey; Cheng, Susan

doi:10.1161/circresaha.122.320825

Cited by 11 publications

(14 citation statements)

References 20 publications

(51 reference statements)

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“…Nevertheless, we believe our findings have implications for our overall understanding of sex differences in health and disease, and show the importance of considering sex and gender differences across all aspects of human health. 48 …”

Section: Discussionmentioning

confidence: 99%

Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based observational study

Hockham

Linschoten

Asselbergs

et al. 2023

bmjmed

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ObjectiveTo assess whether the risk of cardiovascular complications of covid-19 differ between the sexes and to determine whether any sex differences in risk are reduced in individuals with pre-existing cardiovascular disease.DesignRegistry based observational study.Setting74 hospitals across 13 countries (eight European) participating in CAPACITY-COVID (Cardiac complicAtions in Patients With SARS Corona vIrus 2 regisTrY), from March 2020 to May 2021ParticipantsAll adults (aged ≥18 years), predominantly European, admitted to hospital with highly suspected covid-19 disease or covid-19 disease confirmed by positive laboratory test results (n=11 167 patients).Main outcome measuresAny cardiovascular complication during admission to hospital. Secondary outcomes were in-hospital mortality and individual cardiovascular complications with ≥20 events for each sex. Logistic regression was used to examine sex differences in the risk of cardiovascular outcomes, overall and grouped by pre-existing cardiovascular disease.ResultsOf 11 167 adults (median age 68 years, 40% female participants) included, 3423 (36% of whom were female participants) had pre-existing cardiovascular disease. In both sexes, the most common cardiovascular complications were supraventricular tachycardias (4% of female participants, 6% of male participants), pulmonary embolism (3% and 5%), and heart failure (decompensated or de novo) (2% in both sexes). After adjusting for age, ethnic group, pre-existing cardiovascular disease, and risk factors for cardiovascular disease, female individuals were less likely than male individuals to have a cardiovascular complication (odds ratio 0.72, 95% confidence interval 0.64 to 0.80) or die (0.65, 0.59 to 0.72). Differences between the sexes were not modified by pre-existing cardiovascular disease; for the primary outcome, the female-to-male ratio of the odds ratio in those without, compared with those with, pre-existing cardiovascular disease was 0.84 (0.67 to 1.07).ConclusionsIn patients admitted to hospital for covid-19, female participants were less likely than male participants to have a cardiovascular complication. The differences between the sexes could not be attributed to the lower prevalence of pre-existing cardiovascular disease in female individuals. The reasons for this advantage in female individuals requires further research.

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Section: Discussionmentioning

confidence: 99%

Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based observational study

Hockham

Linschoten

Asselbergs

et al. 2023

bmjmed

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“…25 CVD risk increases across the lifespan in both genders, 43 but is relatively low in premenopausal women. 49,50 In our predominantly premenopausal female sample, gender differences in PTSD associations with hypertension may be partially explained by protective effects of estrogen 51 and/or lower CVD incidence among younger women. 50 One study reported a PTSD-hypertension association in younger women 52 but did not examine ASCVD.…”

Section: Ptsd and Gendermentioning

confidence: 96%

“…49,50 In our predominantly premenopausal female sample, gender differences in PTSD associations with hypertension may be partially explained by protective effects of estrogen 51 and/or lower CVD incidence among younger women. 50 One study reported a PTSD-hypertension association in younger women 52 but did not examine ASCVD. However, it is difficult to compare studies of PTSD and CVD among women because of differences in study population (e.g., active-duty in this study vs. veteran or civilian women; sample age); [53][54][55] endpoints studied (e.g., single 14,52 vs. composite CVD diagnoses 16,56-59 ); PTSD assessment method (diagnostic codes vs. questionnaire/interview); [14][15][16] and follow-up length.…”

Section: Ptsd and Gendermentioning

confidence: 96%

PTSD, Comorbidities, Gender, and Increased Risk of Cardiovascular Disease in a Large Military Cohort

Krantz,

Gabbay,

Belleau

et al. 2024

Preprint

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IMPORTANCE: Posttraumatic stress disorder (PTSD) is a prevalent mental health problem that increases risk of cardiovascular disease (CVD). It is not known whether gender or comorbidities modify associations between PTSD and CVD. OBJECTIVE: To assess risk of hypertension and atherosclerotic CVD (ASCVD) associated with PTSD in a predominantly young military population, and determine if gender or PTSD comorbidities modify these associations. DESIGN, SETTING, AND PARTICIPANTS: Using administrative medical records, this longitudinal, retrospective cohort study assessed relationships of PTSD, gender, comorbidities(metabolic risk factors [MRF], behavioral risk factors [BRF], depression, and sleep disorders) to subsequent hypertension and ASCVD among 863,993 active-duty U.S. Army enlisted soldiers (86.2% male; 93.7% <age 40). Using discrete-time survival analysis, person-months with an initial hypertension diagnosis (n=49,656) were compared to an equal-probability control sample. Separate analyses compared person-months with ASCVD (n=2,427) to an equal-probability control sample. MAIN OUTCOMES AND MEASURES: ICD-9-CM diagnoses of hypertension, ASCVD (coronary artery disease, myocardial infarction, stroke, heart failure), PTSD, MRF (Type 2 diabetes, obesity), BRF (tobacco/alcohol use disorders), depression, and sleep disorders. RESULTS: PTSD was associated with subsequent hypertension (OR=3.0 [95% CI=2.9-3.1]), and ASCVD (OR=2.7 [95% CI=2.2-3.3]). These associations remained significant but were attenuated after adjusting for comorbidities and sociodemographic/service-related variables (Hypertension: OR=1.9 [95% CI=1.8-2.0]; ASCVD: OR=1.4 [95% CI=1.2-1.8]). For hypertension, gender and each comorbidity were significant explanatory variables in multivariable models, and there were significant PTSD interactions with gender, MRF, depression, and sleep disorders. Stratifying separately by gender and presence of each comorbidity, PTSD-hypertension associations were stronger among men, those without MRF, without depression, and without sleep disorders. Standardized risk estimates indicated that predicted hypertension rates forthose with vs. without PTSD were higher for men, and for those with vs. without MRF, depression, and sleep disorders. For ASCVD, comorbidities, but not gender, were independent predictors, and associations between PTSD and ASCVD were not modified by gender or comorbidities. CONCLUSIONS: PTSD and comorbidities are independent risk factors for hypertension and ASVD in younger individuals, and gender and comorbid conditions modify PTSD relationships with hypertension. These findings suggest that CVD preventive interventions address PTSD and medical and behavioral comorbidities.

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“…A compendium of research focused on women and CVD was published in 2022. 59 Resources will be critical to advocate relentlessly in support for basic, translational, clinical, population, and implementation research on CVD and stroke prevention and treatment in women of all ages, with specific focus on under-resourced populations and high-reward opportunities for lifelong improvements in cardiovascular health beginning even at young ages. Ensuring that animal studies include female mice with a strategy and plan to assess and disseminate the outcomes of all of these studies as a whole will be important.…”

Section: Call To Actionmentioning

confidence: 99%

Call to Action for Cardiovascular Disease in Women: Epidemiology, Awareness, Access, and Delivery of Equitable Health Care: A Presidential Advisory From the American Heart Association

Wenger¹,

Lloyd-Jones²,

Elkind³

et al. 2022

Circulation

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Addressing the pervasive gaps in knowledge and care delivery to reduce sex-based disparities and achieve equity is fundamental to the American Heart Association’s commitment to advancing cardiovascular health for all by 2024. This presidential advisory serves as a call to action for the American Heart Association and other stakeholders around the globe to identify and remove barriers to health care access and quality for women. A concise and current summary of existing data across the areas of risk and prevention, access and delivery of equitable care, and awareness and education provides a framework to consider knowledge gaps and research needs critical toward achieving significant progress for the health and well-being of all women.

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A Scientific Imperative as Seen Through a Sharpened Lens: Sex, Gender, and the Cardiovascular Condition

Cited by 11 publications

References 20 publications

Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based observational study

Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based observational study

PTSD, Comorbidities, Gender, and Increased Risk of Cardiovascular Disease in a Large Military Cohort

Call to Action for Cardiovascular Disease in Women: Epidemiology, Awareness, Access, and Delivery of Equitable Health Care: A Presidential Advisory From the American Heart Association

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