The importance of Gender to Understand Sex Differences in Cardiovascular Disease.

ABSTRACT Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. There is robust evidence of heterogeneity in underlying mechanism, manifestation, prognosis and response to treatment of CVD between males and females. Gender, which refers to the socially constructed roles, behaviors, expressions, and identities of individuals, is an important determinant of cardiovascular health and its consideration might help for a broader understanding of the observed sex differences in CVD. Established risk factors such as hypertension, dyslipidemia, diabetes mellitus, obesity and smoking are well known to contribute to CVD. However, despite the differences in CVD risk between males and females, most studies looking into the magnitude of effect of each risk factor have traditionally focused on males. While biological sex influences disease pathophysiology, the psycho-socio-cultural construct of gender can further interact with this effect. Behavioural, psychosocial, personal, cultural and societal factors can create, repress, or strengthen underlying biological CV health differences. Although mechanisms of action are largely unclear, it is suggested that gender related factors can further exacerbate the detrimental effect of established risk factors of CVD. In this narrative review we explore the current literature investigating the role of gender in CV risk and its impact upon established risk factors as a fundamental step toward precision medicine.