Are gender-specific differences biologically or socially determined

Disease and society

Women and men get sick differently. Women in particular suffer from rheumatism, depression, thyroid disease and osteoporosis. It is mostly men who die of heart attacks 60 years ago, and sudden cardiac death in athletes almost always affects men. What is less well known is that stress-induced heart disease can be just as deadly as a heart attack and that 90 percent of the time it affects women. Gender medicine researchers deal with these differences: [1] We want to find out which biological and psychosocial mechanisms protect or harm women and men. We investigate why women and men react differently to medication and environmental factors and get sick, what the differences are and what that means for their diseases and treatment. Only then can the best possible diagnosis and therapy be found for both sexes and contribute to both getting older in a healthy way. Which aspects gender physicians investigate is presented in this article using the example of coronary heart disease (KHE) and in particular the project "Gender-Specific Mechanisms in Coronary Artery Disease in Europe" (GenCAD) [2].

Gender differences in heart disease

Not all heart attacks are created equal - there are significant differences between the sexes. I remember a young woman, almost 40 years old, who suddenly wasn't feeling well at work on Friday afternoon; she had nausea, weakness, and stomach and chest pain. Instead of calling for help, she retired to the bathroom. She tried to keep working, it didn't work, she got into trouble with her boss and colleagues and finally went home. The following week she went to see a family doctor. He suspected an upset stomach and prescribed medication. She tried to go back to work the following week, but it didn't get better. She went to a hospital emergency room but was sent home from there as healthy. Despite severe tiredness, nausea and weakness, she tried to go back to work in the weeks that followed. When after a few weeks she was acutely feeling very bad again, she sought help in the nearest pharmacy. Her blood pressure was extremely high and she was sent to another hospital. After a few days, a past heart attack was diagnosed.

What is different here than with a man? For one, the complaints were a little different from what they are in the male-based textbooks. For the woman, weakness and nausea were in the foreground, only after that came stomach and chest pain. On the other hand, those around them reacted differently, as did they themselves: a man aged 60 would immediately have been suspected of having a heart attack. She didn't even think about it herself, neither did the family doctor or the emergency physicians in the first hospital.

As part of the GenCAD project funded by the European Commission, we recently had the opportunity to systematically examine the knowledge about gender differences in heart disease. Heart disease, and especially KHE, should serve as an example of numerous diseases in which there are gender differences.

For this purpose, with the support of the Federal Ministry of Education and Research, we have created a database that will continue to be operated by the Institute for Gender in Medicine at the Charité Berlin. [3] Thanks to automatic updates, it now contains almost 300,000 literature references on gender differences in important diseases, making it the first complete collection to exist. It greatly speeds up the search for literature on gender differences, as all references it contains have already been validated in relation to the research goal of gender differences.

Knowledge
A total of more than 1,000 articles on KHE were evaluated, dealing with the areas of epidemiology, risk factors, prevention, disease mechanisms, clinical symptoms, diagnosis, management and course with gender differences. [4] We found enormous gender differences in disease manifestation - ten years earlier in men than in women - and in risk factors. It has been shown that diabetes is a more serious risk factor in women than in men. New risk factors also emerged, such as rheumatic and autoimmune diseases. Erectile dysfunction is an underestimated and little known risk factor in men, while pregnancy complications are in women. Heart diseases start in the uterus, caused, among other things, by malnutrition during pregnancy, stress, misconduct and harmful environmental influences and affect male and female fetuses differently. Peripheral vascular diseases are underestimated in women and men and play a major role in the impairment of quality of life, especially in women. Secondary prevention goals are achieved less often in women than in men. Socio-economic factors play an increasingly important role.