Medicina di genere e malattie cardiovascolari: che cosa non si è fatto e che cosa si dovrebbe fare

Journal title SALUTE E SOCIETÀ
Author/s Alessia di Giulio, Stefano Taddei
Publishing Year 2014 Issue 2014/1 Language Italian
Pages 14 P. 44-57 File size 696 KB
DOI 10.3280/SES2014-001005
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

Although women believe that cancer is their most important health problem, around 50% of women die for a cardiovascular disease. In addition, despite a different perception, cardiovascular disease is more prevalent in women than in men. The reason for this different incidence of cardiovascular disease between women and men is caused by the fact that fertile woman is protected by estrogen against the development of cardiovascular disease. In contrast, after menopause and the consequent decrease of plasma levels of estrogen, cardiovascular risk in women drammatically increases and, as a consequence, it causes the increase of the incidence of diseases such as myocardial infarction or stroke. Unfortunately, at the present time, no sure information is available about the best practice to prevent or cure cardiovascular disease in women. Most of therapeutical strategies derive from study conducted mainly in men. Studies specifically dedicated to women are only those aimed to evaluate the effect of estrogen replacement therapy on cardiovascular events in post menopausal women and all these studies have produced negative results. The hope for the future is that the new awareness of scientific community about the relevance of cardiovascular disease in women lead to develop specific trials which might give definitive answers for a more effective therapuetic approach.

Keywords: Hypertension, infarction, stroke, prevention, estrogen, menopause

  1. Mosca L., Benjamin E.J., Berra K., Bezanson J.L., Dolor R.J., Lloyd-Jones D.M., Newby L.K., Piña I.L., Roger V.L., Shaw L.J., Zhao D., Beckie T.M., Bushnell C., D’Armiento J., Kris-Etherton P.M., Fang J., Ganiats T.G., Gomes A.S., Gracia C.R., Haan C.K., Jackson E.A., Judelson D.R., Kelepouris E., Lavie C.J., Moore A., Nussmeier N.A., Ofili E., Oparil S., Ouyang P., Pinn V.W., Sherif K., Smith S.C. Jr., Sopko G., Chandra-Strobos N., Urbina E.M., Vaccarino V., Wenger N.K. (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women - 2011 update: a guideline from the American Heart Association. Circulation, 123: 1243-1262, DOI: 10.1161/?CIR.0b013e31820faaf
  2. National Center for Health Statistics. (2010). Health, United States, 2009: with special feature on medical technology. Testo disponibile al sito Accessed May 13, 2013
  3. Pleis J.R., Ward B.W., Lucas J.W. (2010). Summary health statistics for U.S. adults: National Health Interview Survey, 2009. Vital and Health Statistics, Series 10, No. 249. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. DHHS publication No. (PHS) 2011-1577. Testo disponibile al sito Accessed May 13, 2013
  4. Roger V.L., Go A.S., Lloyd-Jones D.M., Adams R.J., Berry J.D., Brown T.M., Carnethon M.R., Dai S., de Simone G., Ford E.S., Fox C.S., Fullerton H.J., Gillespie C., Greenlund K.J., Hailpern S.M., Heit J.A., Ho P.M., Howard V.J., Kissela B.M., Kittner S.J., Lackland D.T., Lichtman J.H., Lisabeth L.D., Makuc D.M., Marcus G.M., Marelli A., Matchar D.B., McDermott M.M., Meigs J.B., Moy C.S., Mozaffarian D., Mussolino M.E., Nichol G., Paynter N.P., Rosamond W.D., Sorlie P.D., Stafford R.S., Turan T.N., Turner M.B., Wong N.D., Wylie-Rosett J. (2011). American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics - 2011 update: a report from the American Heart Association. Circulation, 123: e18-e209, DOI: 10.1161/CIR.0b013e318200970
  5. Vaccarino V., Parsons L., Every N.R., Barron H.V., Krumholz H.M. (1999). Sexbased differences in early mortality after myocardial infarction: National Registry of Myocardial Infarction 2 participants. N Engl J Med, 34: 217-225, DOI: 10.1056/NEJM19990722341040
  6. Vaccarino V., Parsons L., Peterson E.D., Rogers W.J., Kiefe C.I., Canto J. (2009). Sex differences in mortality after acute myocardial infarction. Arch Intern Med, 169: 1767-1774, DOI: 10.1001/archinternmed.2009.33
  7. Wassertheil-Smoller S., Hendrix S.L., Limacher M., Heiss G., Kooperberg C., Baird A., Kotchen T., Curb J.D., Black H., Rossouw J.E., Aragaki A., Safford M., Stein E., Laowattana S., Mysiw W.J., WHI Investigators (2003). Effect of estrogen plus progestin on stroke in postmenopausal women: the Women’s Health Initiative: a randomized trial. JAMA, 289: 2673-2684, DOI: 10.1001/jama.289.20.267
  8. Wenger N.K. (2012). Gender disparity in cardiovascular disease: bias or biology? Expert Rev Cardiovasc Ther, 10(11): 1401-11, DOI: 10.1586/erc.12.13
  9. Writing Group for the Women’s Health Initiative Investigators (2002). Risks and benefits of estrogen plus progestin in healthy post-menopausal women: principal results of the Women’s Health Initiative randomized controlled trial. JAMA, 288: 321-333, DOI: 10.1001/jama.288.3.32
  10. Aldea G.S., Gaudiani J.M., Shapira O.M., Jacobs A.K., Weinberg J., Cupples
  11. A.L., Lazar H.L., Shemin R.J. (1999). Improved clinical outcomes in patients undergoing coronary artery bypass grafting with coronary endarterectomy. Ann Thorac Surg, 67: 1097-1103, DOI: 10.1016/S0003-4975(99)00055-
  12. Alexander K.P., Chen A.Y., Newby L.K., Schwartz J.B., Redberg R.F., Hochman J.S., Roe M.T., Gibler W.B., Ohman E.M., Peterson E.D. (2006). CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress aDverse outcomes with Early implementation of the ACC/AHA guidelines) Investigators. Sex differences in major bleeding with glycoprotein IIb/IIIa inhibitors: results from the CRUSADE initiative. Circulation, 114: 1380-1387, DOI: 10.1161/CIRCULATIONAHA.106.62081
  13. American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2010). Heart disease and stroke statistics - 2010 update: a report from the American Heart Association. Circulation, 121 (7): e46-e215, DOI: 10.1161/CIRCULATIONAHA.109.19266
  14. Barrett-Connor E.L., Cohn B.A., Wingard D.L., Edelstein S.L. (1991). Why is diabetes a stronger risk factor for fatal ischemic heart disease in women than in men? JAMA, 265: 627-631, DOI: 10.1001/jama.1991.0346005008102
  15. Barrett-Connor E., Mosca L., Collins P., Geiger M.J., Grady D., Kornitzer M., McNabb M.A., Wenger N.K. (2006). Raloxifene Use for the Heart (RUTH) Trial Investigators. Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Engl J Med, 355: 125-137, DOI: 10.1056/NEJMoa06246
  16. Dhruva S.S., Bero L.A., Redberg R.F. (2011). Gender bias in studies for Food and Drug Administration premarket approval of cardiovascular devices. Circ Cardiovasc Qual Outcomes, 4: 165-171, DOI: 10.1161/CIRCOUTCOMES.110.95821
  17. Ford E.S., Capewell S. (2007). Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates.
  18. J Am Coll Cardiol, 50: 2128-2132, DOI: 10.1016/j.jacc.2007.05.05
  19. Ford E.S., Ajani U.A., Croft J.B., Critchley J.A., Labarthe D.R., Kottke T.E., Giles W.H., Capewell S. (2007). Explaining the decrease in U.S. deaths from ronary disease, 1980-2000. N Engl J Med, 356: 2388-2398, DOI: 10.1056/NEJMsa0539
  20. Geller S.E., Koch A., Pellettieri B., Carnes M. (2011). Inclusion, analysis, and reporting of sex and race/ethnicity in clinical trials: have we made progress? J Womens Health, 20: 215-220, DOI: 10.1089/jwh.2010.246
  21. Harris D.J., Douglas P.S. (2000). Enrollment of women in cardiovascular clinical trials funded by the National Heart, Lung, and Blood Institute. N Engl J Med, 343: 475-480, DOI: 10.1056/NEJM20000817343070
  22. Healy B. (1991). The Yentyl syndrome. N Engl J Med, 325: 274-276,
  23. 10.1056/NEJM199107253250408
  24. Hochman J.S., Tamis J.E., Thompson T.D., Weaver W.D., White H.D., Van De Werf F., Aylward P., Topol E.J., Calif R.M. (1999). Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb Investigators. Sex, clinical presentation, and outcomes in patients with acute coronary syndromes. N Engl J Med, 341: 226-232, DOI: 10.1056/NEJM19990722341040
  25. Hulley S., Grady D., Bush T., Furberg C., Herrington D., Riggs B., Vittinghoff E. (1998). Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women: Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA, 280: 605-613, DOI: 10.1001/jama.280.7.60
  26. King D.E., Mainous A.G. 3rd, Carnemolla M., Everett C.J. (2009). Adherence to healthy lifestyle habits in US adults, 1988-2006. Am J Med, 122: 528-534, DOI: 10.1016/j.amjmed.2008.11.01
  27. Melloni C., Berger J.S., Wang T.Y., Gunes F., Stebbins A., Pieper K.S., Dolor R.J., Douglas P.S., Mark D.B., Newby L.K. (2010). Representation of women in randomized clinical trials of cardiovascular disease prevention. Circ Cardiovasc Qual Outcomes, 3: 135-142, DOI: 10.1161/CIRCOUTCOMES.110.86830
  28. Miller R.R., Sales A.E., Kopjar B., Fihn S.D., Bryson C.L. (2005). Adherence to heart-healthy behaviors in a sample of the U.S. population. Prev Chronic Dis. Testo disponibile al sito
  29. Mosca L., Appel L.J., Benjamin E.J., Berra K., Chandra-Strobos N., Fabunmi R.P., Grady D., Haan C.K., Hayes S.N., Judelson D.R., Keenan N.L., McBride P., Oparil S., Ouyang P., Oz M.C., Mendelsohn M.E., Pasternak R.C., Pinn V.W., Robertson R.M., Schenck-Gustafsson K., Sila C.A., Smith S.C. Jr., Sopko G., Taylor A.L., Walsh B.W., Wenger N.K., Williams C.L. (2004). American Heart Association Guidelines: Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women. Circulation, 109: 672-669, DOI: 10.1161/?01.ATV.0000114834.85476.8
  30. Mosca L., Mochari H., Christian A., Berra K., Taubert K., Mills T., Arrowood Burdick K., Simpson S.L. (2006). National study of women’s awareness, preventive action, and barriers to cardiovascular health. Circulation, 113: 525-534, DOI: 10.1161/?CIRCULATIONAHA.105.58810
  31. Mosca L., Banka C.L., Benjamin E.J., Berr K., Bushnell C., Ganiats T., Gomes A.S., Gornick H., Gracia C., Gulati M., Haan C.K., Judelson D.R., Keenan N., Kelepouris E., Michos E., Oparil S., Ouyang P., Oz M.C., Petitti D., Pinn V.W., Redberg R., Scott R., Sherif K., Smith S. Jr., Sopko G., Steinhorn R., Stone N.J., Taubert K., Todd B.A., Urbina E., Wenger N. (2007). 2007 Update: American Heart Association evidence-based guidelines for cardiovascular disease prevention in women. Circulation, 115: 1481-1501, DOI: 10.1161/?CIRCULATIONAHA.107.18154

Alessia di Giulio, Stefano Taddei, Medicina di genere e malattie cardiovascolari: che cosa non si è fatto e che cosa si dovrebbe fare in "SALUTE E SOCIETÀ" 1/2014, pp 44-57, DOI: 10.3280/SES2014-001005