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  • Human Rights Research Center

Heart Disease in a Male-Centric Healthcare System

February 28, 2024



The impact of anatomical, genetic, and molecular differences on heart disease is significant (Greiten, 2014). However, research studies on heart failure have predominantly excluded females. The existing literature on the biological and psychosocial factors that impact coronary heart disease is not comprehensive enough for physicians to use for female patients. This has led to a male-centered approach to treating heart disease in females. Unfortunately, both physicians and the devices used in coronary heart disease treatment often neglect the needs of female patients, leading to compromised outcomes. There is not a lot that has been done to remedy this in recent years. Heart disease is the leading cause of death in the United States, and it is a human rights violation that such clear sex-related disparities exist in the medical treatment of heart disease.


Comparing female and male subjects in research is crucial for understanding the differences in disease progression and treatment between the sexes. A study found that 80% of animals used for testing across 10 fields of biology were male, indicating a significant gender bias in animal research. Furthermore, only one third of studies that included female subjects analyzed the results with consideration of the subjects’ sexes (Nunamaker, 2023). Key differences exist between males and females and findings from research involving one sex cannot be generalized to the other. Doing this consistently is a major cause for subpar medical care in females.


Aside from the biological differences between males and females, there are also psychosocial factors that influence disease progression. One study found that biological factors and psychosocial factors were both shown to influence coronary heart disease equally (Barrett-Connor, 2013). Both biological and psychosocial factors should be studied with consideration of sex, and the medical treatments for coronary heart disease should be tailored accordingly. Females may be disproportionately affected by psychosocial factors, such as smoking, family history, and certain types of inflammation, in relation to coronary heart disease (Roeters van Lennep, 2002). However, counseling for lifestyle factors in patients with coronary heart disease remains the same for both sexes. Research suggests that treating psychosocial factors with the same importance of medical interventions can lead to better outcomes for patients with heart disease (Roncella, 2019). Just like the role of biological factors on coronary heart disease, there is work that needs to be done to improve the treatment of females who suffer from this.


There should be literature with stricter guidelines for providers to use when considering the treatment of coronary heart disease. This is a necessity due to the biases of healthcare workers, which can affect the care of patients based on their sex. Research indicates that male physicians tend to prescribe fewer heart disease medications and lower doses when treating female patients compared to male patients, (Baumhäkel, 2009); which is problematic and further affects the health of females who are suffering from heart disease. Females, who often exhibit atypical symptoms, often receive less appropriate treatment than males (Khamis, 2016). Considering these symptoms atypical is due to the lack of research considering female symptoms and their medical treatment is directly impacted by this.


In addition to the physician bias impacting female patients’ outcomes, medical devices designed based on male research may be less effective for females. One example is implantable cardioverter-defibrillators (ICDs), used in people with advanced coronary heart disease. These devices detect heart rhythms and administer shocks when necessary. Research indicates that ICDs may shock females less appropriately than males (Hsich, 2019). Further research is needed to determine the suitability of ICDs as a therapy for coronary heart disease in females.


Individualized care considering sex and gender is essential. More data on sex-based differences in mechanistic and regulatory processes (Miller, 2014) and psychosocial factors is needed. Physician bias and medical devices currently favor male patients due to insufficient research on females with coronary heart disease. This constitutes a human rights violation, as we have the capability to provide equal care to both males and females with coronary heart disease but fail to do so.


 

Sources


  1. Barrett-Connor E. Gender differences and disparities in all-cause and coronary heart disease mortality: epidemiological aspects. Best Pract Res Clin Endocrinol Metab. 2013 Aug;27(4):481-500. doi: 10.1016/j.beem.2013.05.013. Epub 2013 Jul 8. Erratum in: Best Pract Res Clin Endocrinol Metab. 2013 Dec;27(6):831. PMID: 24054926; PMCID: PMC3781943. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3781943/ 

  2. Baumhäkel M, Müller U, Böhm M. Influence of gender of physicians and patients on guideline-recommended treatment of chronic heart failure in a cross-sectional study. Eur J Heart Fail. 2009 Mar;11(3):299-303. doi: 10.1093/eurjhf/hfn041. Epub 2009 Jan 21. PMID: 19158153; PMCID: PMC2645055. https://onlinelibrary.wiley.com/doi/10.1093/eurjhf/hfn041 

  3. Greiten LE, Holditch SJ, Arunachalam SP, Miller VM. Should there be sex-specific criteria for the diagnosis and treatment of heart failure? J Cardiovasc Transl Res. 2014 Mar;7(2):139-55. doi: 10.1007/s12265-013-9514-8. Epub 2013 Nov 9. PMID: 24214112; PMCID: PMC3935102. https://link.springer.com/article/10.1007/s12265-013-9514-8 

  4. Hsich EM. Sex Differences in Advanced Heart Failure Therapies. Circulation. 2019 Feb 19;139(8):1080-1093. doi: 10.1161/CIRCULATIONAHA.118.037369. PMID: 30779645; PMCID: PMC6383806. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.037369?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed 

  5. Khamis RY, Ammari T, Mikhail GW. Gender differences in coronary heart disease. Heart. 2016 Jul 15;102(14):1142-9. doi: 10.1136/heartjnl-2014-306463. Epub 2016 Apr 28. PMID: 27126397. https://spiral.imperial.ac.uk/handle/10044/1/32653 

  6. Miller VM. Why are sex and gender important to basic physiology and translational and individualized medicine? Am J Physiol Heart Circ Physiol. 2014 Mar;306(6):H781-8. doi: 10.1152/ajpheart.00994.2013. Epub 2014 Jan 10. PMID: 24414073; PMCID: PMC3949049. https://journals.physiology.org/doi/full/10.1152/ajpheart.00994.2013?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org 

  7. Nunamaker EA, Turner PV. Unmasking the Adverse Impacts of Sex Bias on Science and Research Animal Welfare. Animals (Basel). 2023 Sep 2;13(17):2792. doi: 10.3390/ani13172792. PMID: 37685056; PMCID: PMC10486396. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10486396/#:~:text=This%20sex%20bias%20in%20biomedical,results%20by%20sex%20%5B4%5D.

  8. Roncella A. Psychosocial Risk Factors and Ischemic Heart Disease: A New Perspective. Rev Recent Clin Trials. 2019;14(2):80-85. doi: 10.2174/1574887114666190301141628. PMID: 30836925. https://pubmed.ncbi.nlm.nih.gov/30836925/ 

  9. Roeters van Lennep JE, Westerveld HT, Erkelens DW, van der Wall EE. Risk factors for coronary heart disease: implications of gender. Cardiovasc Res. 2002 Feb 15;53(3):538-49. doi: 10.1016/s0008-6363(01)00388-1. PMID: 11861024. https://academic.oup.com/cardiovascres/article/53/3/538/324835?login=false 

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