In developed countries, women are well aware that cardiovascular disease is the leading cause of death in women. Nevertheless, the condition they fear most is breast cancer despite the fact that death rates from breast cancer have been falling since the 1990s.
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Physicians are less likely to suspect heart disease in women with chest pain and less likely to perform diagnostic and therapeutic cardiac procedures in women.
Breast cancer is the second leading cause of cancer death in women, but it causes about 60% fewer deaths than does lung cancer. Men are substantially more likely to die from suicide, homicide, and accidents than are women.
Lately, biologic processes that differ between males and females and gender difference for features related to social influences are being studied as separate fields of medicine.
Alzheimers disease (AD) affects approximately twice as many women as men. Because the risk for AD increases with age, part of this sex difference is accounted for by the fact that women live longer than men. However, additional factors probably contribute to the increased risk for AD in women, including sex differences in brain size, structure, and functional organization.
Estrogens have pleiotropic genomic and nongenomic effects on the central nervous system, including neurotrophic actions in key areas involved in cognition and memory. Women with AD have lower endogenous estrogen levels than do women without AD. These observations have led to the hypothesis that estrogen is neuroprotective.
Cardiovascular disease: Women also have longer QT intervals on electrocardiograms, and this increases their susceptibility to certain arrhythmias. Animal studies suggest that the sex difference in the duration of the QT interval is caused by the effects of sex steroids on cardiac repolarization, in part related to their effects on cardiac voltage-gated potassium channels; there is a lower density of the rapid component (IKr) of the delayed rectifier potassium current (IK) in females.
Women undergoing CABG surgery have more advanced disease, a higher perioperative mortality rate, less relief of angina, and less graft patency; however, 5- and 10-year survival rates are similar. Women undergoing percutaneous transluminal coronary angioplasty have lower rates of initial angiographic and clinical success than men, but they also have a lower rate of restenosis and a better long-term outcome.
Elevated cholesterol levels, hypertension, smoking, obesity, low HDL cholesterol levels, DM, and lack of physical activity are important risk factors for CHD in both men and women. Total triglyceride levels are an independent risk factor for CHD in women but not in men.
Diabestes: Women are more sensitive to insulin than men are. Despite this, the prevalence of type 2 DM is similar in men and women. Polycystic ovary syndrome and gestational DM—common conditions in premenopausal women—are associated with a significantly increased risk for type 2 DM.
Hypertension: After age 60, hypertension is more common in U.S. women than in men, largely because of the high prevalence of hypertension in older age groups and the longer survival of women. Isolated systolic hypertension is present in 30% of women >60 years.
The effectiveness of various antihypertensive drugs appears to be comparable in women and men; however, women may experience more side effects. For example, women are more likely to develop cough with angiotensin-converting enzyme inhibitors.
Most autoimmune disorders occur more commonly in women than in men; they include autoimmune thyroid and liver diseases, lupus, rheumatoid arthritis (RA), scleroderma, multiple sclerosis (MS), and idiopathic thrombocytopenic purpura.
The prevalence of obesity is higher in women than in men. Further, >80% of patients who undergo bariatric surgery are women. Pregnancy and menopause are risk factors for obesity. There are major sex differences in body fat distribution. Women characteristically have gluteal and femoral or gynoid pattern of fat distribution, whereas men typically have a central or android pattern. Women have more subcutaneous fat than men. Gonadal steroids appear to be the major regulators of fat distribution through a number of direct effects on adipose tissue. Studies in humans also suggest that gonadal steroids play a role in modulating food intake and energy expenditure.
Osteoporosis is about five times more common in postmenopausal women than in age-matched men, and osteoporotic hip fractures are a major cause of morbidity in elderly women. Men accumulate more bone mass and lose bone more slowly than do women. Sex differences in bone mass are found as early as infancy. Calcium intake, vitamin D, and estrogen all play important roles in bone formation and bone loss.
VIOLENCE AGAINST WOMEN
Domestic violence is the most common cause of physical injury in women, exceeding the combined incidence of all other types of injury (such as from rape, mugging, and auto accidents). Sexual assault is one of the most common crimes against women. One in five adult women in the United States reports having experienced sexual assault during her lifetime. Adult women are much more likely to be raped by a spouse, ex-spouse, or acquaintance than by a stranger. Domestic violence may be an unrecognized feature of certain clinical presentations, such as chronic abdominal pain, headaches, substance abuse, and eating disorders, in addition to more obvious manifestations such as trauma.
Women’s health is now a mature discipline, and the importance of sex differences in biologic processes is well recognized. There has been a striking reduction in the excess mortality rate from myocardial infarction in younger women. Nevertheless, ongoing misperceptions about disease risk not only among women but also among their physicians result in inadequate attention to modifiable risk factors.