Gender Differences in Heart Disease

Amber has pretty much covered everything to be said for this topic, so I thought I'd add some interesting information I found for some light reading! - Maria Nguyen

Pictured below is the Kalin and Zumoff graph, a well-known diagram depicting the gender differences in coronary heart disease (CHD) death rates in a wide range of countries. What is remarkable is that the male-to-female ratio for fatal CHD seems consistent over countries that have very different CHD mortality experiences, keeping a general ratio of 2.5 to 4.5. It seems that it is only in China that the CHD rates do not vary in terms of gender.

There have been many theories as to why there is such a gender gap in CHD rates. The idea that men engage in more unhealthy behaviours compared to women (e.g. cigarette smoking, alcohol abuse, eating red meat and less fruits and vegetables, and exposure to physical hazards), and are harmed by the pressures of their work, while women nurture and care at home, have been popular explanations for the higher rates of heart disease in men. However, studies have shown that only low-level work (e.g. clerks) and limited education are associated with increased risk of heart attack, and that women that enjoy success in their careers (e.g. executives) have more favourable heart disease risk factors than women who stayed home.

However, it has been suggested that social supports may be cardioprotective, and that men’s reluctance to share feelings and resulting inward anger may have biological consequences, with increased levels of stress hormones among others factors.

Coronary-Prone behaviour: In studies done by Friedman and Rosenman, it was shown that behaviours characterised by aggressiveness, anger, competitiveness, hostility and time urgency were associated with higher risk of heart disease in both men and women – however, these characteristics are more typical of the ‘masculine’ personality.

In terms of biology, coronary artery blood flow seems to be improved by oestrogen in women, rapidly reversing the vasoconstriction of atherosclerotic coronary arteries caused by acetylcholine in a London study by Collins et al. However, the administration of oestrogen doesn’t seem to affect blood flow in men.

Sources: http://www.circ.ahajournals.org/cgi/content/full/95/1/252