Biological sex (being female or male) significantly influences the course of disease. This simple fact must be considered in all cardiovascular diagnosis and therapy. However, major gaps in knowledge about and awareness of cardiovascular disease in women still impede the implementation of sex-specific strategies. Among the gaps are a lack of understanding of the pathophysiology of women-biased coronary artery disease syndromes (spasms, dissections, Takotsubo syndrome), sex differences in cardiomyopathies and heart failure, a higher prevalence of cardiomyopathies with sarcomeric mutations in men, a higher prevalence of heart failure with preserved ejection fraction in women, and sex-specific disease mechanisms, as well as sex differences in sudden cardiac arrest and long QT syndrome. Basic research strategies must do more to include female-specific aspects of disease such as the genetic imbalance of 2 versus one X chromosome and the effects of sex hormones. Drug therapy in women also needs more attention. Furthermore, pregnancy-associated cardiovascular disease must be considered a potential risk factor in women, including pregnancy-related coronary artery dissection, preeclampsia, and peripartum cardiomyopathy. Finally, the sociocultural dimension of gender should be included in research efforts. The organization of gender medicine must be established as a cross-sectional discipline but also as a centered structure with its own research resources, methods, and questions.

Biological sex (being female or male) significantly influences the course of disease. This simple fact must be considered in all cardiovascular diagnosis and therapy. However, major gaps in knowledge about and awareness of cardiovascular disease in women still impede the implementation of sex-specific strategies. Among the gaps are a lack of understanding of the pathophysiology of women-biased coronary artery disease syndromes (spasms, dissections, Takotsubo syndrome), sex differences in cardiomyopathies and heart failure, a higher prevalence of cardiomyopathies with sarcomeric mutations in men, a higher prevalence of heart failure with preserved ejection fraction in women, and sex-specific disease mechanisms, as well as sex differences in sudden cardiac arrest and long QT syndrome. Basic research strategies must do more to include female-specific aspects of disease such as the genetic imbalance of 2 versus one X chromosome and the effects of sex hormones. Drug therapy in women also needs more attention. Furthermore, pregnancy-associated cardiovascular disease must be considered a potential risk factor in women, including pregnancy-related coronary artery dissection, preeclampsia, and peripartum cardiomyopathy. Finally, the sociocultural dimension of gender should be included in research efforts. The organization of gender medicine must be established as a cross-sectional discipline but also as a centered structure with its own research resources, methods, and questions.
Cardiomyopathies ; Cardiovascular Diseases ; Coronary Artery Disease ; Coronary Vessels ; Death, Sudden, Cardiac ; Diagnosis ; Drug Therapy ; Female ; Gonadal Steroid Hormones ; Heart Failure ; Humans ; Long QT Syndrome ; Male ; Peripartum Period ; Pre-Eclampsia ; Prevalence ; Risk Factors ; Sex Characteristics ; X Chromosome

OBJECTIVEThe purpose of this study was to explore the association of gender and age on in-hospital mortality after coronary artery bypass graft (CABG) among the Chinese population.

METHODSA total of 2682 patients (male: 2316, female: 366) who underwent CABG surgery were retrospectively investigated between January 1st, 1997 and December 31st, 2001 for perioperative risk factors and in-hospital mortality rate after CABG.

RESULTSPreoperative comorbidity rate and postoperative complication rate were higher in women than that in men, although left ventricular ejection fraction was higher and the number of diseased vessels fewer in women than in men. The in-hospital mortality rate was three times higher in women than that in men (3.01% vs. 1.12%, P = 0.001), especially in the younger age group (2.6% vs. 0.5%, P = 0.001, risk-adjusted odds ratio 4.844, 95% CI: 1.549 - 15.142). In older patients, there was no notable difference in in-hospital mortality between the genders (3.7% for women vs. 2.4% for men, P = 0.383).

CONCLUSIONSChinese woman, especially in younger age, had a higher in-hospital mortality rate post CABG than that in men, suggesting that younger female gender is an independent risk factor for in-hospital mortality after CABG. Future studies are warranted to clarify the underlying mechanisms.

Age Factors ; Aged ; China ; epidemiology ; Coronary Artery Bypass ; mortality ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Postoperative Period ; Risk Factors ; Sex Factors