What a difference an X makes: Sex differences in cardiovascular disease, stroke, and more

Women are not simply smaller forms than men. But for many decades, the medicine has not included women in studies of common diseases (e.g., cardiovascular disease, stroke) and medications.

Sep 2nd, 2015
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This article originally appeared in RDH eVillage Focus, a newsletter prepared for dental professionals looking for hard-hitting, current information. You can subscribe here.

Heart disease is a serious concern for both men and women. Recent studies have revealed that cardiovascular disease affects female and male bodies differently. After decades of being overlooked in heart health research, women are finally getting some attention in this and many other areas of health. This article will explore some of the sex differences unique to women and men.

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Cardiovascular health
When the American Heart Association held its first public conference for women in 1964, the name of the event was “Hearts to Husbands.” (1) In the areas of heart and cardiovascular research, women traditionally have been underrepresented in heart studies, partially because of hormone variations that could alter the results. However, women are not simply smaller men. There are changes seen even at a molecular level. As a result, the American Heart Association (AHA) created Go Red for Women. The AHA discusses symptoms and warning signs of heart attack, stroke, and cardiac arrest in women here.

STROKE WARNING SIGNS (3)
Spot a stroke F.A.S.T.:

- Face Drooping Does one side of the face droop or is it numb? Ask the person to smile.
- Arm Weakness is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
- Speech Difficulty is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like "the sky is blue." Is the sentence repeated correctly?
- Time to call 9-1-1 if the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately.

Medications
Most medication studies have been done on male animals or white men. For example, we know that taking aspirin can be helpful for preventing heart attacks, according to Bayer Aspirin. However, the 1989 milestone study that underscored the drug's effectiveness in these situations included over 20,000 men, and no women. (2) Regarding sleep medication, the percentage of adults using a prescription sleep aid increased with age and education. More adult women (5.0%) used prescription sleep aids than adult men (3.1%). (3) In spite of this, it took 20 years (2013) after the drug Ambien became available for the Food and Drug Administration (FDA) cut the recommended dosage of Ambien for women in half from 10 mg to 5 mg for the immediate release version. (4) There are any examples available of how drugs are metabolized differently in men and women, and require attention to prescribing instructions. (5)

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Brain differences
Memory declines more rapidly in women than men. (6) Also, researchers from the Oregon Health & Science University reported that among older patients, women exposed to general anesthesia during surgery declined on measures of cognition, functional status, and brain volumes at meaningfully faster rates than men and that the difference was more pronounced for women who underwent multiple procedures. (7)

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Many brain disorders vary between the sexes. According to a Northwestern University research team, male and female brains function differently at a molecular level. This was seen in the molecular regulation of synapses in the hippocampus, a brain region involved in learning and memory, responses to stress, and epilepsy. (8) This shows in part why males and female brains may respond differently to drugs that target certain synaptic pathways.

And lastly, new research conducted in London has found an increasing trend in the number of people in the UK reaching age 100 over the past two decades. (9) The study also found that, whilst women were far more likely to reach 100 than men, men tended to be healthier and had fewer diagnosed chronic illnesses compared to women. (9) The same is true in the United States, women tend to live longer than men, but with more chronic diseases.

References
1. Moyer MW. Heart Health Basic for Women. Better Homes and Gardens. http://www.bhg.com/health-family/conditions/heart-disease/heart-health-basics-for-women/. Accessed September 1, 2015.
2. Steering Committee of the Physicians' Health Study Research Group. Final Report on the Aspirin Component of the Ongoing Physicians' Health Study. N Engl J Med. 1989;321:129-135.
3. NCHS Data Brief. Prescription Sleep Aid Use Among Adults: United States, 2005–2010. Number 127, August 2013. CDC website. http://www.cdc.gov/nchs/data/databriefs/db127.htm. Updated August 29, 2013. Accessed September 1, 2015.
4. Gardner A. FDA: Lower Ambien’s Dose to Prevent Drowsy Driving. WebMD News.http://www.webmd.com/sleep-disorders/news/20130515/fda-lower-ambiens-dose-to-prevent-drowsy-driving. Accessed September 1, 2015.
5. Worth T. Drugs that Work Differently in Women and Men. Everyday Health. http://www.everydayhealth.com/news/drugs-work-differently-woman-than-man/. Updated February 19, 2015. Accessed September 1, 2015.
6. Lin KA et al. #P4-108. Alzheimer's Association International Conference. “Marked Gender Differences in the Rate of Cognitive Decline in Subjects at Risk for Alzheimer’s Disease." July 18-23, 2015; Washington, D.C.
7. Schenning K et al. #P1-264. Alzheimer's Association International Conference “The Role of Sex in Postoperative Cognitive and Functional Decline." July 18-23, 2015; Washington, D.C.
8. Tabatadze N, Huang G, May RM, Jain A, Woolley CS. Sex Differences in Molecular Signaling at Inhibitory Synapses in the Hippocampus. J Neurosci. 2015;35:11252-11265.
9. Hazra NC, Dregan A, Jackson S, Gulliford MC. Differences in Health at Age 100 According to Sex: Population-Based Cohort Study of Centenarians Using Electronic Health Records. J Am Geriatr Soc. 2015;63:1331-7.


Maria Perno Goldie, RDH, MS, is editorial director of RDH eVillage Focus.

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