Haben Sie Fragen zu den unten stehenden Publikationen, wenden Sie sich bitte an Frau Dr. Ute Seeland über folgende E-Mail-Adresse: ute.seeland@charite.de. Sie berät Sie gerne weiter.

Neue Risikofaktoren für kardiovaskuläre Erkrankungen

Link zum Artikel (PDF) / © 2022 Thieme

Autorin: PD. Dr. med. Ute Seeland
Fachärztin für Innere Medizin, Gendermedizinerin DGesGM
Charité – Universitätsmedizin Berlin; Gastprofessur Universitätsmedizin Mainz

Das Buch "ELSEVIER ESSENTIALS Männermedizin“ ist seit dem 17.05.2022 im Buchhandel erhältlich.

Onlineshop von ELSEVIER:
https://shop.elsevier.de/elsevier-essentials-maennermedizin-9783437235351.html

oder bei LEHMANNS: https://www.lehmanns.de/shop/medizin-pharmazie
(Unter "Blick ins Buch" finden Sie auch das vollständige Inhaltsverzeichnis als PDF)

Autoren:

Beschreibung: Der Hausarzt - meist erste Anlaufstelle bei gesundheitlichen Problemen

Bei männlichen Patienten kommen oft andere Themen zur Sprache als bei Frauen. Deshalb braucht der Allgemeinmediziner spezielles Wissen über männerspezifische Themen und Symptome. Neben häufigen Erkrankungen des kardiovaskulären Systems und der Prostata spielen auch heikle Themen wie sexuelle Funktionsstörungen, Hormonveränderungen und Depression eine Rolle.

Das Buch ESSENTIALS Männermedizin gibt Ihnen das notwendige Rüstzeug, um Ihre männlichen Patienten kompetent und erfolgreich zu begleiten.

Das Buch eignet sich für:

• Allgemeinmediziner*innen (Hausärzt*innen)
• Internist*innen (Hausärzt*innen)

Sex and Gender Aspects in Vascular Ageing -
Focus on Epidemiology, Pathophysiology, and Outcomes

Website: https://www.heartlungcirc.org/article/S1443-9506(21)01147-1/fulltext

Review Heart Lung Circ 2021 Nov;30(11):1637-1646. doi: 10.1016/j.hlc.2021.07.006. Epub 2021 Aug 25.

Ute Seeland 1, János Nemcsik 2, Mai Tone Lønnebakken 3, Karolina Kublickiene 4, Helena Schluchter 5, Chloe Park 6, Giacomo Pucci 7, Ioana Mozos 8, Rosa-Maria Bruno 9, Sex and Gender VascAgeNet Expert Group

PMID: 34452844 DOI: 10.1016/j.hlc.2021.07.006

ABSTRACT

Sex and gender are important modifiers of cardiovascular system physiology, pathophysiology, and disease development. The atherosclerosis process, together with the progressive loss of arterial elasticity with age, is a major factor influencing the development of overt cardiovascular, renal, and cerebrovascular disease. While differences between women and men in epidemiology and pathophysiology of vascular ageing are increasingly reported, sex-disaggregated data are still scarcely available for prospective studies. A better knowledge of sex differences in physiological ageing as well as in disease-related changes in vascular ageing trajectories is crucial to avoid misdiagnosis and mistreatment. This review presents key concepts and knowledge gaps identified in vascular ageing due to gonadal function, vascular physiology, pathophysiology, psychosocial factors, pregnancy, and prognostic relevance. Gender roles determine the effectiveness of any cardiovascular preventive strategy and acceptance for non-invasive or invasive diagnostics and therapeutics. Gender differences in health behaviour, also due to sociocultural norms conditioned by society, contribute to behaviours that may lead to premature arterial vascular ageing. These include differences in risk behaviours like smoking, diet, exercise, and in stress, but also conditions such as housing, noise pollution, poverty, disability, and any kind of stigmatisation. The VascAgeNet Gender Expert Group aims to advance the use of non-invasive vascular ageing measures in routine clinical settings by providing facts to fill in the gaps concerning sex and gender differences at each step of this process, and to search for solutions.

Sensitive to Infection but Strong in Defense -
Female Sex and the Power of Oestradiol in the COVID-19 Pandemic

Website: https://www.frontiersin.org/articles/10.3389/fgwh.2021.651752/full

Front. Glob. Womens Health, 11 May 2021

Louise Newson1, Isaac Manyonda2, Rebecca Lewis1, Robert Preissner3, Saskia Preissner4 and Ute Seeland3*

1 Newson Health Ltd, Winton House, Stratford-upon-Avon, United Kingdom

2 Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom

3 Institute of Physiology and Science-IT, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

4 Department Oral and Maxillofacial Surgery, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

ABSTRACT

The incidence of SARS-CoV2 infections is around 15% higher in premenopausal women compared to age matched men, yet the fatality rate from COVID-19 is significantly higher in men than women for all age strata. Sex differences have also been observed in recent epidemics including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), with SARS-CoV 2 virus infection sex differences appear more dramatic. The regulation and expression of the angiotensin converting enzyme 2 (ACE2) is the key for this special coronavirus SARS-CoV-2 to enter the cell. 17β-oestradiol increases expression level and activity of angiotensin converting enzyme-2 (ACE2) and the alternative signaling pathway of Ang II via the angiotensin II receptor type II (AT2R) and the Mas receptor is more dominant in female sex than in male sex. Maybe a hint to explain the higher infection risk in women. The same hormonal milieu plays a major role in protecting women where morbidity and mortality are concerned, since the dominant female hormone, oestradiol, has immune-modulatory properties that are likely to be protective against virus infections. It is also known that the X chromosome contains the largest number of immune-related genes, potentially conferring an advantage to women in efficient immune responsiveness. Lifestyle factors are also likely to be contributory. Premenopausal women could possibly face higher exposure to infection (hence higher infection rates) because economic conditions are often less favorable for them with less opportunity for home office work because of jobs requiring mandatory attendance. Due to the additional task of childcare, it is likely that contact times with other people will be longer. Women generally make healthier lifestyle choices, thus reducing the disease burden that confers high risk of mortality in COVID-19 infected men. This narrative review aims to present key concepts and knowledge gaps on the effects of oestrogen associated with SARS-CoV2 infection and COVID-19 disease.

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Quantitative and Qualitative Analysis on Sex and Gender in Preparatory Material for National Medical Examination in Germany and the United States

Website:

https://journals.sagepub.com/doi/10.1177/2382120519894253?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

J Med Educ Curric Dev 2020 Jan 10;7:2382120519894253. doi: 10.1177/2382120519894253. eCollection Jan-Dec 2020.

Helena Schluchter 1, Ahmad T Nauman 1, Sabine Ludwig 2, Vera Regitz-Zagrosek 1 3 4, Ute Seeland 1 4


BACKGROUND
Sex- and gender-based medicine (SGBM) should be a mandatory part of medical education. We compared the quantity and quality of sex- and gender-related content of e-learning materials commonly used by German and American medical students while preparing for national medical examinations.

METHODS
Quantitative, line-by-line analysis of the preparatory materials AMBOSS 2017 and USMLE Step 1 Lecture Notes (2017) by KAPLAN MEDICAL was performed between April and October 2017. Subjects were allocated to one of the three main fields: clinical subjects, behavioral and social science, and pharmacology. Qualitative analysis comprised binary categorization into sex- and gender-based aspects and qualification with respect to the presence of a pathophysiological explanation for the sex or gender difference.

RESULTS
In relation to the total content of AMBOSS and KAPLAN, the sex- and gender-based share of the clinical subjects content was 26.8% (±8.2) in AMBOSS and 21.1% (±10.2) in KAPLAN. The number of sex- and gender-based aspects in the behavioral and social science learning material differed significantly for AMBOSS and KAPLAN (4.4% ± 3.1% vs 10.7% ± 7.5%; P = .044). Most of the sex- and gender-related content covered sex differences. Most learning cards and texts did not include a detailed pathophysiological explanation for sex- or gender-based aspects. The knowledge provided in the preparatory documents represents only a small part of facts that are already known about sex and gender differences.

CONCLUSIONS
The preparatory materials focused almost exclusively on biological sex differences and the sociocultural dimension in particular is underrepresented. A lot more evidence-based facts are known and should be integrated into the materials to reflect the importance of SGBM as an integral component of patient-centered medicine.

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Evidence for treatment with estradiol for women with SARS-CoV-2 infection

Website: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01851-z

Ute Seeland, Flaminia Coluzzi, Maurizio Simmaco, Cameron Mura, Philip E. Bourne, Max Heiland, Robert Preissner & Saskia Preissner

BMC Medicine volume 18, Article number: 369 (2020)

BACKGROUND
Given that an individual’s age and gender are strongly predictive of coronavirus disease 2019 (COVID-19) outcomes, do such factors imply anything about preferable therapeutic options?

METHODS
An analysis of electronic health records for a large (68,466-case), international COVID-19 cohort, in 5-year age strata, revealed age-dependent sex differences. In particular, we surveyed the effects of systemic hormone administration in women. The primary outcome for estradiol therapy was death. Odds ratios (ORs) and Kaplan-Meier survival curves were analyzed for 37,086 COVID-19 women in two age groups: pre- (15–49 years) and peri-/post-menopausal (> 50 years).

RESULTS
The incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is higher in women than men (by about + 15%) and, in contrast, the fatality rate is higher in men (about + 50%). Interestingly, the relationships between these quantities are linked to age: pre-adolescent girls and boys had the same risk of infection and fatality rate, while adult premenopausal women had a significantly higher risk of infection than men in the same 5-year age stratum (about 16,000 vs. 12,000 cases). This ratio changed again in peri- and postmenopausal women, with infection susceptibility converging with men. While fatality rates increased continuously with age for both sexes, at 50 years, there was a steeper increase for men. Thus far, these types of intricacies have been largely neglected. Because the hormone 17ß-estradiol influences expression of the human angiotensin-converting enzyme 2 (ACE2) protein, which plays a role in SARS-CoV-2 cellular entry, propensity score matching was performed for the women’s sub-cohort, comparing users vs. non-users of estradiol. This retrospective study of hormone therapy in female COVID-19 patients shows that the fatality risk for women > 50 years receiving estradiol therapy (user group) is reduced by more than 50%; the OR was 0.33, 95% CI [0.18, 0.62] and the hazard ratio (HR) was 0.29, 95% CI [0.11,0.76]. For younger, pre-menopausal women (15–49 years), the risk of COVID-19 fatality is the same irrespective of estradiol treatment, probably because of higher endogenous estradiol levels.

CONCLUSIONS
As of this writing, still no effective drug treatment is available for COVID-19; since estradiol shows such a strong improvement regarding fatality in COVID-19, we suggest prospective studies on the potentially more broadly protective roles of this naturally occurring hormone.

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  Sex differences in arterial wave reflection and the role of exogenous and endogenous sex hormones: results of the Berlin Aging Study II

Seeland U, Demuth I, Regitz-Zagrosek V, Steinhagen-Thiessen E, König M. J Hypertens. 2020;38(6):1040-1046. doi:10.1097/HJH.0000000000002386

ABSTRACT

Background: Arterial stiffness is tightly linked to hypertension. Sex differences in hypertension and arterial stiffness have already been established, yet the role of sex hormones is not precisely defined. This study examined age and sex differences of arterial wave reflection and associations with  endogenous and exogenous sex hormones in women.

Methods: Pulse wave analysis was performed with an oscillometric device in 590 male and 400 female participants of the Berlin Aging Study II. Participants have been recruited from two age-strata, 22–35 years and 60–82 years. Data on exposures and potential confounders, including medication, have been collected at baseline visit.

Results: Aumentation index (AIx) and pulse wave velocity increased with age. Mean AIx was higher in women than in men. Multivariable regression analysis showed a positive association between use of oral contraceptive pills (OCPs) and AIx controlling for confounders (age, BMI, current smoking, central blood pressure), with a significantly higher mean AIx in OCP-users compared with nonusers (mean group difference: 4.41; 95% confidence interval 1.61–7.22). Per quartile decrease in estradiol level AIx increased by 1.72 (95% confidence interval 0.43–3.00). In OCP users endogenous estradiol was largely suppressed.

Conclusion: The findings suggest important sex differences in measures of arterial wave reflection, with a higher mean AIx observed in women compared with men. OCPs may promote the development of hypertension by increasing AIx. Suppressed endogenous estradiol levels may be responsible for this increased wave reflection due to increased vasotonus of the small and medium arteries.

KONGRESSBRIEF GENDERGESUNDHEIT: Editorial

 Quantitative and Qualitative Analysis on Sex and Gender in Preparatory Material for National Medical Examination in Germany and the United States

Schluchter H, Nauman AT, Ludwig S, Regitz-Zagrosek V, Seeland U., J Med Educ Curric Dev. 2020;7:2382120519894253. Published 2020 Jan 10. doi:10.1177/2382120519894253

ABSTRACT

Background: Sex- and gender-based medicine (SGBM) should be a mandatory part of medical education. We compared the quantity and quality of sex- and gender-related content of e-learning materials commonly used by German and American medical students while preparing for national medical examinations.

Methods: Quantitative, line-by-line analysis of the preparatory materials AMBOSS 2017 and USMLE Step 1 Lecture Notes (2017) by KAPLAN MEDICAL was performed between April and October 2017. Subjects were allocated to one of the three main fields: clinical subjects, behavioral and social science, and pharmacology. Qualitative analysis comprised binary categorization into sex- and gender-based aspects and qualification with respect to the presence of a pathophysiological explanation for the sex or gender difference.

Results: In relation to the total content of AMBOSS and KAPLAN, the sex- and gender-based share of the clinical subjects content was 26.8% (±8.2) in AMBOSS and 21.1% (±10.2) in KAPLAN. The number of sex- and gender-based aspects in the behavioral and social science learning material differed significantly for AMBOSS and KAPLAN (4.4% ± 3.1% vs 10.7% ± 7.5%; P = .044). Most of the sex- and genderrelated content covered sex differences. Most learning cards and texts did not include a detailed pathophysiological explanation for sex- or gender-based aspects. The knowledge provided in the preparatory documents represents only a small part of facts that are already known about sex and gender differences.

Conclusions: The preparatory materials focused almost exclusively on biological sex differences and the sociocultural dimension in particular is underrepresented. A lot more evidence-based facts are known and should be integrated into the materials to reflect the importance of SGBM as an integral component of patient-centered medicine.

Adverse Drug Reactions to Guideline-Recommended Heart Failure Drugs in Women

(A Systematic Review of the Literature)

JACC: HEART FAILURE VOL.7, NO.3, 2019

ABSTRACT

OBJECTIVES This study sought to summarize all available evidence on sex differences in adverse drug reactions (ADRs) to heart failure (HF) medication.

BACKGROUND Women are more likely to experience ADRs than men, and these reactions may negatively affect women’s immediate and long-term health. HF in particular is associated with increased ADR risk because of the high number of comorbidities and older age. However, little is known about ADRs in women with HF who are treated with guideline-recommended drugs.

METHODS A systematic search of PubMed and EMBASE was performed to collect all available information on ADRs to angiotensin-converting enzyme inhibitors, b-blockers, angiotensin II receptor blockers, mineralocorticoid receptor antagonists, ivabradine, and digoxin in both women and men with HF.

RESULTS The search identified 155 eligible records, of which only 11 (7%) reported ADR data for women and men separately. Sex-stratified reporting of ADRs did not increase over the last decades. Six of the 11 studies did not report sex differences. Three studies reported a higher risk of angiotensin-converting enzyme inhibitor–related ADRs in women, 1 study showed higher digoxin-related mortality risk for women, and 1 study reported a higher risk of mineralocorticoid receptor antagonist–related ADRs in men. No sex differences in ADRs were reported for angiotensin II receptor blockers and b-blockers. Sex-stratified data were not available for ivabradine.

CONCLUSIONS These results underline the scarcity of ADR data stratified by sex. The study investigators call for a change in standard scientific practice toward reporting of ADR data for women and men separately. (J Am Coll Cardiol HF 2019;7:258–66) © 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

  Update 2018 der ESC-Leitlinie zu kardiovaskulären Erkrankungen in der Schwangerschaft

(Herz 8 / 43)

Zusammenfassung:

Herzerkrankungen sind in den westlichen Ländern die häufigste Ursache für den Tod der Mutter während einer Schwangerschaft. Die aktuelle ESC-Leitlinie 2018 zu Herz-Kreislauf-Erkrankungen in der Schwangerschaft ist ein Handlungsleitfaden für jede Ärztin und jeden Arzt, die vor der Herausforderung stehen, schwangere Frauen mit kardiovaskulären Erkrankungen zu betreuen. Zu den neuen Konzepten gegenüber 2011 gehören die Empfehlungen, das mütterliche Risiko aufgrund der modifizierten Klassifikation der Weltgesundheitsorganisation (mWHO) einzustufen, die Einführung des „Schwangerschafts-Herz-Teams“, Hinweise zur assistierten Fertilitätstherapie, differenzierte Empfehlungen zur Antikoagulation für Frauen mit niedrigem und hohem Dosisbedarf an Vitamin-K-Antagonisten sowie die mögliche Verwendung von Bromocriptin bei der peripartalen Kardiomyopathie. Die FDA(Food and Drug Administration)-Kategorien A bis D und X sollen nicht mehr verwendet werden. Daher wurde die Tabelle zu den Arzneimitteln durch detaillierte Informationen aus tierexperimentellen und humanen Studien zum Risiko für Mutter und Fetus ergänzt. Die neuen Erkenntnisse zu den spezifischen Herzerkrankungen werden in den jeweiligen Kapiteln ausführlich dargestellt.

  Update of the ESC guidelines 2018 on cardiovascular diseases during pregnancy

(European Heart Journal (2018))

Abstract:

Heart diseases are the most common cause of maternal death during pregnancy in Western countries. The current ESC guidelines 2018 for the management of cardiovascular diseases during pregnancy is a guide for any physician facing the challenge of caring for pregnant women with cardiovascular diseases. Among the new concepts compared to 2011, are recommendations to classify maternal risk due to the modified World Health Organization (mWHO) classification, introduction of the pregnancy heart team, guidance on assisted reproductive therapy, specific recommendations on anticoagulation for low-dose and high-dose requirements of vitamin K antagonists and the potential use of bromocriptine in peripartum cardiomyopathy. The Food and Drug Administration (FDA) categories A–D and X should no longer be used. Therefore, the table of drugs was completed with detailed information from animal and human studies on maternal and fetal risks. The new findings on specific heart diseases are presented in detail in the respective chapters.

Geschlecht und Herz-Kreislauf-Erkrankungen
Warum wir Gendermedizin brauchen

(Der Internist Ausgabe 4-2017)

Ein Textauszug:

Geschlechterunterschiede bei Risikofaktoren für Herz-Kreislauf-Erkrankungen

Kardiovaskuläre Risikofaktoren nehmen bei  Frauen  zu,  vor  allem  Stoffwechselerkrankungen  und  Übergewicht,  negative Veränderungen im Lebensstil, Rauchen, zu  geringe  körperliche Belastung und  vermehrter Stress im  Alltag.  Stress spielt bei Frauen und Männern eine Rolle in  der  Entstehung  von  Herzerkrankungen.  Er  wurde  jedoch  kürzlich  in  der VIRGO-Studie  als  wichtiger  Risikofaktor für das Auftreten und den schlechten Verlauf eines Myokardinfarkts bei Frauen  identifiziert.  Nach älteren  Studien  unterscheiden  sich  die  wahrscheinlich krank machenden Stressformen bei Frauen und Männern. Dies wurde jedoch nicht in neueren Studien überprüft.

Diabetes fördert das Auftreten einer koronaren Herzkrankheit bei Frauen stärker als bei Männern.

Diabetes  ist  ein wichtiger Risikofaktor, der das Auftreten einer koronaren Herzkrankheit bei Frauen stärker fördert als bei  Männern.  Altersabhängig  erhöht er bei Frauen das Risiko für das Auftreten einer Herz-Kreislauf-Erkrankungumdas 5- bis 7-fache, bei Männern um das 3- bis 4-fache. Damit gleicht sich das absolute Risiko der Frauen und  Männer mit Diabetes an.  
Häufigere  Komorbiditäten wie  Übergewicht  und  chronische  Entzündungen  sowie  ungünstige  Veränderungen im Gerinnungssystem und in der Endothelfunktion tragen wahrscheinlich zum größeren relativen kardiometabolischen Risiko bei diabetischen Frauen bei [3].  Die  Frühstadien  des  Diabetes  bzw. der  Prädiabetes,  der  bei  älteren  Euro- päern bereits eine Prävalenz von bis zu 40 % erreicht hat und mit einem erhöhten kardiovaskulären Risiko einhergeht, unterscheiden sich  ebenfalls  bei  Männern und Frauen. Frauen haben eher eine gestörte Glukosetoleranz, Männer früher pathologische Nüchternglukosewerte. Rauchen ist ein wichtiger Risikofaktor bei  Frauen  und  Männern.  Die  europäischen Zahlen sagen,  dass immer mehr junge Frauen rauchen. Die Nichtraucherkampagnen haben die Männer bisher anscheinend besser erreicht als die Frauen.

Sex in basic research: concepts in the cardiovascular field

(Cardiovascular Research (2017))

Abstract:

Women and men, female and male animals and cells are biologically different, and acknowledgement of this fact is critical to advancing medicine. However, incorporating concepts of sex-specific analysis in basic research is largely neglected, introducing bias into translational findings, clinical concepts and drug development. Research funding agencies recently approached these issues but implementation of policy changes in the scientific community is still limited, probably due to deficits in concepts, knowledge and proper methodology. This expert review is based on the EUGenMed project (www.eugenmed.eu) developing a roadmap for implementing sex and gender in biomedical and health research. For sake of clarity and conciseness, examples are mainly taken from the cardiovascular field that may serve as a paradigm for others, since a significant amount of knowledge how sex and oestrogen determine the manifestation of many cardiovascular diseases (CVD) has been accumulated. As main concepts for implementation of sex in basic research, the study of primary cell and animals of both sexes, the study of the influence of genetic vs. hormonal factors and the analysis of sex chromosomes and sex specific statistics in genome wide association studies (GWAS) are discussed. The review also discusses methodological issues, and analyses strength, weaknesses, opportunities and threats in implementing sex-sensitive aspects into basic research.

Pregnancy and risk of cardiovascular disease:
is the relationship due to childbearing or childrearing?

(Cardiopuls 2017)

Pregnancy has long been considered as a risk factor for cardiovascular disease.
However, recent evidence showing similar relationships between the number of children and cardiovascular disease in men suggests that childrearing is more likely than childbearing to affect the risk of cardiovascular disease.

Bioscience Reports (2016) 36

Prevalence of arterial stiffness and the risk of myocardial diastolic dysfunction in women

Synopsis
The present study determines the prevalence of vascular dysfunction and arterial stiffness (ASt) in a female urban population by measuring the brachial augmentation index (AIx) and aortic pulse wave velocity (PWV). The study tests the hypothesis that the measurement of AIx and PWV is useful in addition to that of traditional cardiovascular risk factors when assessing the risk for left ventricular diastolic dysfunction (LVDD). This cross-sectional study recruited 965 women aged 25–75 years from 12 districts of Berlin. The ASt indices, brachial AIx, aortic PWV and the central blood pressure were measured by an oscillometric method. A randomly selected subgroup (n = 343) was examined by echocardiography. Trans-mitral inflow E/A ratio and diastolic mitral annulus velocity (´e) were assessed.
Questionnaires, medical history and blood sampling were used for the evaluation of individual risk factors. Normal vascular function was found in 55% of the women included. The prevalence of women with pathological AIx only (AIx −10%, PWV normal) was 21.5%, whereas 17.9% were affected by increased AIx and PWV (AIx  −10%, PWV 9.7 m/s), and 6% with only pathological PWV values. The prevalence of LVDD was 31.7%. LVDD was significantly associated with pathological PWV  9.7 m/s [OR: 1.27, 95%CI: 1.02–1.57], age [OR: 4.17, 95%CI: 2.87–6.07] and a waist circumference >80 cm [OR: 3.61, 95%CI: 1.85–7.04] in multiple regression analysis. The high prevalence of markers for vascular dysfunction and ASt in a general female population and their importance as a mediator of diastolic dysfunction should encourage implementation of aortic PWV measurement to improve cardiovascular-risk assessment in particular to identify subclinical myocardial diastolic dysfunction.

eGender - from e-Learning to e-Research:
a web-based interactive knowledge-sharing platform for sex- and gender-specific medical education

Abstract

Background: Sex and Gender Medicine is a novel discipline that provides equitable medical care for society and improves outcomes for both male and female patients. The integration of sex- and gender-specific knowledge into medical curricula is limited due to adequate learning material, systematic teacher training and an innovative communication strategy. We aimed at initiating an e-learning and knowledge-sharing platform for Sex and Gender Medicine, the eGender platform (http://egender.charite.de), to ensure that future doctors and health professionals will have adequate knowledge and communication skills on sex and gender differences in order to make informed decisions for their patients.

Methods: The web-based eGender knowledge-sharing platform was designed to support the blended learning pedagogical teaching concept and follows the didactic concept of constructivism. Learning materials developed by Sex and Gender Medicine experts of seven universities have been used as the basis for the new learning tools. The content of these tools is patient-centered and provides add-on information on gender-sensitive aspects of diseases. The structural part of eGender was designed and developed using the open source e-learning platform Moodle. The eGender platform comprises an English and a German version of e-learning modules: one focusing on basic knowledge and seven on specific medical disciplines. Each module consists of several courses corresponding to a disease or symptom complex. Self-organized learning has to be managed by using different learning tools, e.g., texts and audiovisual material, tools for online communication and collaborative work.

Results: More than 90 users from Europe registered for the eGender Medicine learning modules. The most frequently accessed module was “Gender Medicine-Basics” and the users favored discussion forums. These elearning modules fulfill the quality criteria for higher education and are used within the elective Master Module “Gender Medicine-Basics” implemented into the accredited Master of Public Health at Charité-Berlin.

European Heart Journal Advance Access published November 3, 2015
Gender in cardiovascular diseases: impact on clinical manifestations, management and outcomes:

Introduction

In the vast majority of cardiovascular diseases (CVDs), there are well-described differences between women and men in epidemiology, pathophysiology, clinical manifestations, effects of therapy, and outcomes. 1 – 3 These differences arise on one hand from biological differences among women and men, which are called sex differences.
They are due to differences in gene expression from the sex chromosomes and subsequent differences in sexual hormones leading to differences in gene expression and function in the CV system, e.g. in vascular function and NO signalling, in myocardial remodelling under stress, or metabolism of drugs by sexspecific cytochrome expression. Sex differences are frequently reproducible in animal models. In contrast, gender differences are unique to the human. They arise from sociocultural processes, such as different behaviours of women and men; exposure to specific influences of the environment; different forms of nutrition, lifestyle, or stress; or attitudes towards treatments and prevention.
These are equally important for CVDs. Both sex and gender (S&G) influence human development (Figure 1). Since it is almost impossible to distinguish properly between effects of S&G in the medical field, the EUGenMed writing group decided to discuss both of them together and to use the term S&G for all medical relevant differences between women and men in the present review ...