Quality and Equitable Health Care Gaps for Women

Shaw, Leslee J.; Pepine, Carl J.; Xie, Joe; Mehta, Puja K.; Morris, Alanna A.; Dickert, Neal W.; Ferdinand, Keith C.; Gulati, Martha; Reynolds, Harmony R.; Hayes, Sharonne N.; Itchhaporia, Dipti; Mieres, Jennifer H.; Ofili, Elizabeth; Wenger, Nanette K.; Merz, C. Noel Bairey

doi:10.1016/j.jacc.2017.05.051

Cited by 93 publications

(43 citation statements)

References 92 publications

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“…Many factors lead to sex-specific differences in disease incidences and manifestations and in therapeutic efficacy [ 74 ]. These include cell-intrinsic genetic and cell-extrinsic physiological dissimilarities, as well as environmental circumstances such as healthcare inequities [ 75 ]. Although increased attention is now paid to social and organismal contrasts between males and females, far less is known regarding the impact of sex on biochemical signaling mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Unanswered Questions Regarding Sex and BMP/TGF-β Signaling

Shah

Rogers

2018

JDB

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Crosstalk between the BMP and TGF-β signaling pathways regulates many complex developmental processes from the earliest stages of embryogenesis throughout adult life. In many situations, the two signaling pathways act reciprocally. For example, TGF-β signaling is generally pro-fibrotic, whereas BMP signaling is anti-fibrotic and pro-calcific. Sex-specific differences occur in many diseases including cardiovascular pathologies. Differing ratios of fibrosis and calcification in stenotic valves suggests that BMP/TGF-β signaling may vary in men and women. In this review, we focus on the current understanding of the interplay between sex and BMP/TGF-β signaling and pose several unanswered questions.

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Section: Discussionmentioning

confidence: 99%

Unanswered Questions Regarding Sex and BMP/TGF-β Signaling

Shah

Rogers

2018

JDB

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“…Integration of Sex-and Gender-Based Approaches in Cardiovascular Research: The Case of Ischemic Heart Disease Even though the individual's sex is among the most important modulators of cardiovascular disease (CVD) risk and response to treatment, the integration of sex in research and clinical decision-making is yet overlooked [1][2][3]. In the era of precision medicine, reporting on sex-and gender-related variables in clinical trials has become necessary in order to understand how they interact and influence cardiovascular health [1][2][3]. However, some issues stem from the terminology biases among published literature: while the term Bsex^should be used when reporting biological aspects, the term Bgender^is more appropriate when reporting gender identity and psychosocial/cultural factors [1].…”

Section: Rationalementioning

confidence: 99%

Sex and Gender Differences in Ischemic Heart Disease: Endocrine Vascular Disease Approach (EVA) Study Design

Raparelli

Proietti

Lenzi

et al. 2018

J. of Cardiovasc. Trans. Res.

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Improvements in ischemic heart disease (IHD) management have been unbalanced between sexes, with coronary microvascular dysfunction considered the likely underlying reason. The Endocrine Vascular disease Approach (EVA) is an observational study (Clinicaltrial.gov NCT02737982) aiming to assess sex and gender interactions between coronary circulation, sexual hormones, and platelet function. Consecutive patients with IHD undergoing coronary angiography will be recruited: (1) to assess sex and gender differences in angiographic reperfusion indexes; (2) to evaluate the effects of estrogen/androgen on sex-related differences in myocardial ischemia; (3) to investigate the platelet biology differences between men and women with IHD; (4) to verify sexand gender-driven interplay between response to percutaneous coronary intervention, platelets, sex hormones, and myocardial damage at baseline and its impact on 12-month outcomes. The integration of sex and gender in this translational project on IHD will contribute to the identification of new targets for further innovative clinical interventions. Keywords Sex. Gender. Coronary microvascular dysfunction. Sex steroid hormones. Platelet function. Clinical outcomes. Myocardial blush grade Abbreviations 1VD One-vessel disease 2VD Two-vessel disease 3VD Three-vessel disease ACS Acute coronary syndrome AR Androgen receptors CAD Coronary artery disease CMD Coronary microvascular dysfunction CMR Cardiac magnetic resonance CVD Cardiovascular disease E2 Estradiol eCRFs Electronic case report forms ER Estrogen receptor GP Glycoprotein IHD Ischemic heart disease INOCA Ischemia and no obstructive CAD MACE Major adverse cardiovascular events MBG Myocardial blush grade MMAS-4 Morisky Medication Adherence Scale-4 Items NOS Nitric oxide synthase NOX2 NADPH oxidase 2 NSTEMI Non-ST elevation myocardial infarction PCI Percutaneous coronary intervention STEMI ST elevation myocardial infarction (c)TFC (corrected) TIMI frame count Associate Editor Enrique Lara-Pezzi oversaw the review of this article

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“…77,78 Additionally, the social determinants of CVD in women have been much discussed, including health literacy, lower education, low-wage jobs, higher rates of poverty, and more familial responsibilities, coupled with societal discriminatory norms and practices. 40 At the same time, physicians also appear to ahow gaps regarding women's cardiac health. In particular, physicians are more likely to assign a lower CVD risk category to female patients and underestimate CVD risk in women.…”

Section: Discussionmentioning

confidence: 99%

“…5,38,39 In 2017, a state-of-the-art review was published in the Journal of the American College of Cardiology that synthesized evidence and discussed issues related to health-care quality and equity for women, including minority-population subgroups. 40 The same year, the results of a survey conducted by the Women's Heart Alliance were revealed, summarizing the knowledge, gapstherein, and perceptions, of women as well as physicians regarding CVD in women. 41 FDA Office of Women's Health-funded projects have contributed to highlighting major gaps in the field of CVDs in women.…”

Section: Female-centered Policies and Practices In Global Cvdmentioning

confidence: 99%

<p>Cardiovascular Diseases in Women: Policies and Practices Around the Globe to Achieve Gender Equity in Cardiac Health</p>

Kouvari¹,

Souliotis²,

Yannakoulia³

et al. 2020

RMHP

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The women's global health agenda has recently been reformulated to address more accurately cardiovascular disease (CVD) prevention, diagnosis, and treatment. The aim of the present work was to review the global and national policies and practices that address sex equality in health with a focus on CVDs in women. Scientific databases and health organizations' websites that presented/discussed policies and initiative targeting to enhance a sex-centered approach regarding general health and/or specifically cardiac health care were reviewed in a systematic way. In total, 61 relevant documents were selected. The selected policies and initiatives included position statements, national action plans, evidence-based guidelines, guidance/recommendations, awareness campaigns, regulations/legislation, and state-of-the art reports by national/international projects and conferences. The target audiences of large stakeholders (eg, American Heart Association, European Society of Cardiology, Centers for Disease Control and Prevention) were female citizens, health professionals, and researchers. Much as policy-makers have recognized the sex/gender gap in the CVD field, there is still much to be done. Thereby, tailor-made strategies should be designed, evaluated, and delivered on a global and most importantly a national basis to achieve gender equity with regard to CVDs.

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Quality and Equitable Health Care Gaps for Women

Cited by 93 publications

References 92 publications

Unanswered Questions Regarding Sex and BMP/TGF-β Signaling

Unanswered Questions Regarding Sex and BMP/TGF-β Signaling

Sex and Gender Differences in Ischemic Heart Disease: Endocrine Vascular Disease Approach (EVA) Study Design

<p>Cardiovascular Diseases in Women: Policies and Practices Around the Globe to Achieve Gender Equity in Cardiac Health</p>

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