Explain sex and gender influence on health and disease in select chronic conditions.
Explain sex and gender differences in medication response for select chronic conditions.
Summarize literature pertaining to chronic diseases that impact women's health.
Compare and contrast prevention and treatment interventions for select chronic conditions between women and men.
To achieve optimal pharmacotherapy in women, health care providers must understand the impact of sex and gender on disease presentation and effectiveness and safety of medications. Presently, the scientific evidence has documented many sex/gender differences that are clinically important to health care providers. This chapter is an overview of some sex/gender differences emphasizing chronic diseases and medication response based upon available data. Examples of some of the concepts discussed below are listed in Tables 7-1, 7-2, 7-3.
Table 7-1Examples of Sex and Gender Differences in Disease Prevalence ||Download (.pdf) Table 7-1 Examples of Sex and Gender Differences in Disease Prevalence
|Diseases ||More/Greater Than Men ||Less/Smaller/Fewer Than Men ||Referencesa |
|Cardiovascular ||Stroke and mortality with atrial fibrillation, hospital mortality with acute coronary syndrome, mortality after acute myocardial infarction, strokes with more poststroke depression ||Obstructive heart disease, hypertension in young female adult years ||2, 4, 5, 10, 32 |
|Gastrointestinal disorders || |
Irritable bowel syndrome, Crohn’s disease, obesity
|Ulcerative colitis ||47, 51, 53, 54, 64 |
|Mental health ||Depression, anxiety || ||68, 69 |
|Substance abuse ||In younger female adults, alcoholism ||Illicit medication use ||88, 89, 105 |
|Autoimmune diseases ||Rheumatoid arthritis || ||114 |
|Bone and joint ||Osteoporosis; hand, foot, and knee osteoarthritis ||Mortality after osteoporotic fracture, hip osteoarthritis ||125, 130 |
|Neurologic disorders ||Multiple sclerosis, chronic fatigue syndrome ||Epilepsy ||164 |
Table 7-2Examples of Sex Gender Differences in Disease Physiology and Pathophysiology ||Download (.pdf) Table 7-2 Examples of Sex Gender Differences in Disease Physiology and Pathophysiology
| ||More/Greater Than Men ||Less/Smaller/Fewer Than Men ||Referencesa |
|Cardiovascular ||Heart rate; impact of autoimmune diseases; altered presentation of strokes with more pain, headache, and mental changes ||Heart and coronary arteries, chest pain with ischemia ||1, 2, 5, 14, 33, 34 |
|Mental health ||Suicidal attempts, different neural circuits ||Suicidal deaths, downregulation of negative emotional reactions to fear and stress ||66, 69 |
|Substance abuse disorders ||Nicotine dependence onset; adverse effects from alcohol such as sexual dysfunction, liver cirrhosis, and cardiomyopathy ||Alcohol dehydrogenase ||75, 80, 90, 92, 96, 97 |
|Autoimmune disorders ||Immune reactivity || ||115 |
|Bone and joint ||Tibial and patellar cartilage loss, obesity effect on joints ||Knee cartilage volume ||130 |
|Neurologic disorders ||Earlier onset of multiple sclerosis ||Progression of multiple sclerosis to disability ||154, 155 |