Breast cancer is a typically female pathology, and I think everyone would agree with this statement, but in the case of cardiovascular diseases, it’s common opinion that they are predominantly male diseases. But is that really the case?
An authoritative source, the European Society of Cardiology (ESC), has recently published data showing that 51% of women die of cardiovascular disease, while only 3% are victims of breast cancer. Analyzing the data even more in detail, it can be seen that in 2012, deaths from heart attack and stroke in Italy were 37,000 in women and 24,000 in men — or, 13,000 more women died than men. The data are from eight years ago, and current estimates confirm this trend.
But why is this difference and perception far from the reality of the facts?
There are historical reasons: cardiovascular diseases (and heart attacks in particular) are associated with men because of their intense physical and sports-focused activity. And reasons for diagnosis: the symptoms in women are different, and often, women are under-diagnosed and therefore under-treated. In women, heart attacks can occur with symptoms such as nausea, vomiting, difficulty breathing, jaw pain, tiredness and palpitations. In men, the classic symptoms are retro sternal chest constrictive pain, radiating into the left arm, and stomach pain, as if something had not been digested.
But the differences between men and women are also many others. We can cite the well-known diseases of the urogenital system in the uterus and ovaries that are clearly female, but there are many other diseases that have higher incidence and mortality in women than in men. Let us take a few examples:
- Cardiovascular disease, as we’ve already said
- Neurological diseases (headache and depression)
- Immune system diseases (multiple sclerosis and rheumatoid arthritis)
- Autoimmune thyroid diseases and scleroderma, which are seven-to-ten times more frequently found in women than in men
- Alzheimer’s disease and dementia, affecting twice as many women after the age of 65 as men
And other pathologies that can be found in the Notebooks of the Ministry of Health.
This higher incidence and severity of some diseases in women than in men doesn’t go hand-in-hand with drugs and their study. In fact, going back to the example of cardiovascular diseases, epidemiological studies are carried out in 70-to-80% of cases on men. The experimentation of new drugs generally starts on male animal models and ends with the so-called clinical trials, in which almost only men are enrolled. Why? The reasons lie in the fact that the woman’s menstrual cycle would complicate the study and increase the costs; moreover, a possible pregnancy would force the interruption of the tests and face ethical problems that would affect the health of the unborn child.
But does developing a drug by testing it only on men affect its effectiveness?
It certainly does. For example, the size of the organs and the different concentration of enzymes can change the effectiveness of treatments. In addition, women have a fat mass that is on average 25% higher than that of men of the same age, and this also affects the metabolism of the drug. Hormones are very different between men and women, and this has a big impact on the dissipation of the drug, especially in menopausal women, pregnant women or during the menstrual cycle. In other words, the woman may find herself taking too much or too little medication, with consequences not always predictable or monitorable by her Doctor.
Is it reasonable to think of a gender-based medicine?
Absolutely yes! In fact, universities are also moving this way, and there are currently five universities in Europe that have set up this training path — in the course of the Degree in Medicine. One of these universities is in Padua, and in 2018, also the University of Florence initiated a Second-Level Master’s degree.
In addition to training, it’s also necessary to consider the costs associated with gender-based medicine; however, data from the Medicine Agency (AIFA), show that women in 2017 consumed more drugs than men, and also showed an adverse drug reaction that is almost double to that of men. In fact, 60% of female admissions to hospital is attributable to the adverse effects of medicines.
In conclusion, women are not simple copies of men in the same way that children are not small adults and elderly adults are differently young — so on the road to precision and personalized medicine, it’s increasingly necessary to dig into the details of each individual pathology and adopt an age and gender-specific approach.
This post is also available in: Italiano