Female Gender Disparities in Cardiovascular Term Paper

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Gender variation in clinical decision-making was measured, including (1) the number, types, and certainty levels of diagnoses considered and (2) how diagnoses vary according to patient characteristics, when patients have identical symptoms of CHD (Maserejian et al., 2009).

This was a factorial experiment presenting videotaped CHD symptoms, systematically altering patient gender, age, socioeconomic status (SES) and race, and physician gender and level of experience. The primary end point was physicians' most certain diagnosis. The results: Physicians (n=128) mentioned five diagnoses on average, most commonly heart, gastrointestinal, and mental health conditions. Physicians were significantly less certain of the underlying cause of symptoms among female patients regardless of age, but only among middle-aged women were they significantly less certain of the CHD diagnosis. Among middle-aged women, 31.3% received a mental health condition as the most certain diagnosis, compared with 15.6% of their male counterparts. An interaction effect showed that females with high SES were most likely to receive a mental health diagnosis as the most certain.

Middle-aged female patients were diagnosed with the least confidence, whether for CHD or non- CHD conditions, indicating that their gender and age combination misled physicians, particularly toward mental health alternative diagnoses. Physicians should be aware of the potential for psychological symptoms to erroneously take a central role in the diagnosis of younger women.

Innate differences in gender physiology result in unique exposures, risk, and protection that are specific to women. Recognition and appreciation of these differences results in better treatment adaptations for women and better outcomes. Disparities between genders in the treatment of major cardiovascular risk factors still exist and are mostly secondary to underestimating or misunderstanding a woman's risk. Preventive therapies are less often recommended to women. Women are more likely to be diagnosed and treated for hypertension, but are less likely to reach treatment goals. Through understanding these disparities, health care providers will be better able to screen female patients and institute evidence-based therapies for the prevention of cardiovascular disease (Jarvie & Foody, 2010).

Table 1

Author(s), Year

Level of Evidence

Shirato and Swan, 2010

Level I

Nancy N. Maserejian, Carol L. Link, Karen L. Lutfey, Lisa D. Marceau, and John B. McKinlay, 2009

Level II

By Holli a. DeVon, RN, PhD, Catherine J. Ryan, RN, PhD, APRN, CCRN, Amy L. Ochs, BSN, and Moshe Shapiro, MS, 2008

Level IV

Gisele S. Silva, Fabricio O. Lima, Erica C.S. Camargo, Wade S. Smith, Michael H. Lev, Gordon J. Harris, Elkan F. Halpern, Walter Koroshetz, and Karen L. Furie, 2010

Level IV

Borejda Xhyheri and Raffaele Bugiardini, 2010

Level V

Vlassis N. Pyrgakis, 2010

Level VII

Jerome Roncalli, Meyer Elbaza, Nicolas Dumonteila, Nicolas Boudoua, Olivier Laireza, Thibault Lhermusiera, Talia Chilona, Cecile Baixasa, Michel Galinier, Jacques Puela,, Jean-Marie Fauvela, Didier Carriea, Jean-Bernard Ruidavetsc, 2010

Level II

Chiara Melloni, Jeffrey S. Berger, Tracy Y. Wang, Funda Gunes, Amanda Stebbins, Karen S. Pieper, Rowena J. Dolor, Pamela S. Douglas, Daniel B. Mark, L. Kristin Newby, 2010

Level I

Chiara Melloni, Kristi Newby, 2009

Level VII

Alice K. Jacobs, 2009

Level V

Ann F. Chou, Sarah Hudson Scholle, Carol S. Weisman, Arlene S. Bierman, Rosaly Correa-de-Araujo, and Lori Mosca 2007

Level IV

Jennifer L. Jarvie & JoAnne M. Foody, 2010

Level V

Nina P. Paynter, Daniel I. Chasman, Guillaume Pare, Julie E. Buring, Nancy R. Cook, Joseph P. Miletich, and Paul M. Ridker, 2010

Level IV

Krantz, M. Olson, J. Francis, C. Phankao, N.B. Merz, G. Sopko, D. Vido,

L.J. Shaw, D.S. Sheps, C. Pepine, K. Matthews and Wise Investigators, 2006

Level IV

Table II

Article Topic/Category

Main Points Scanned, Organized and Categorized


Multiple factors contribute to more cardiovascular complications in women. Women present atypical symptoms and are affected later in life relative to men.

Women relative to men have a greater risk of mortality from cardiovascular disease with respect to smoking, diabetes and hypertension and have been victims of inequity in the health system due to lack of data.

Case Control- Cohort Study

Gender disparities in cardiovascular disease may be due to innate features of female biology and lack of intervention in the health system.

Gender disparities in the management and outcomes of CVD exist among patients in commercial managed care plans despite similar access to care. The differences in patterns of care demonstrate the need for interventions tailored to address gender disparities

Gender and age combinations mislead physicians particularly toward mental health diagnosis alternatives.

Randomized Clinical Trial

Regular use of low-dose aspirin may reduce the risk of MI in women.

Women are less likely to achieve independence after acute ischemic stroke.

Systematic Meta-Reviews

Research suggests several gaps in knowledge related to the prevention of cardiovascular disease must be addressed to optimize the cardiovascular health of women.

Enrollment of women in randomized clinical trials has increased over time but remains low relative to their overall representation in disease populations. Efforts are needed to reach a level of representation that is adequate to ensure evidence-based sex-specific recommendations.

Works Cited

Chou, Anne F., Sarah Hudson Scholle, Carol S. Weisman, Arlene S. Bierman, Rosaly

Correa-de-Araujo, & Lori Mosca (2007). "Gender Disparities in the Quality of Cardiovascular Disease Care in Private Managed Care Plans." In Women's Health

Issues 17: 120 -- 130.

DeVon, H., Ryan, C.J., Ochs, a.L., & Shapiro, M. (2008). "Symptoms Across the Continuum of Acute Coronary Syndromes: Differences Between Women and Men." In Am J. Crit Care 17:14-24.

Jacobs, Alice K. (2009). "Coronary Intervention in 2009: Are Women No Different Than

Men?" In Circ Cardiovasc Interv 2:69-78.

Jarvie, J.L. & Foody, J.M. (2010). "Recognizing and Improving Health Care

Disparities in the Prevention of Cardiovascular Disease in Women." In Curr

Cardiol Rep 12:488 -- 496.

Krantz, D.M. Olson, J. Francis, C. Phankao, N.B. Merz, G. Sopko, D. Vido,

L.J. Shaw, D.S. Sheps, C. Pepine, K. Matthews & Wise Investigators (2006).

"Anger, Hostility, and Cardiac Symptoms in Women with Suspected Coronary

Artery Disease: The Women's Ischemia Syndrome Evaluation (WISE) Study." in

Journal of Women's Health 15: 1214-1223.

Maserejian, Nancy J., Carol L. Link, Karen L. Lutfey, Lisa D. Marceau & John B.

McKinlay (2009). "Disparities in Physicians' Interpretations of Heart Disease

Symptoms by Patient Gender: Results of a Video Vignette Factorial Experiment."

In Journal of Women's Health 18: 1661-1667.

Melloni, Chiara & Kristi Newby (2009). "Sex Differences in Medical Care After Acute

Myocardial Infarction: what can be done to address the problem." In Women's

Health 5: 339-341.

Melloni, Chiara, Jeffrey S. Berger, Tracy Y. Wang, Funda Gunes, Amanda Stebbins,

Karen S. Pieper, Rowena J. Dolor, Pamela S. Douglas, Daniel B. Mark & L.

Kristin Newby. (2010). "Prevention Representation of Women in Randomized

Clinical Trials of Cardiovascular Disease." Circ Cardiovasc Qual Outcomes 3:


Paynter, Nina P., Daniel I. Chasman, Guillaume Pare, Julie E. Buring, Nancy R. Cook,

Joseph P. Miletich, & Paul M. Ridker (2010). "Association between a Literature-

Based Genetic Risk Score and Cardiovascular Events in 19,313 Women." in

JAMA 303(7): 631 -- 637.

Pyrgakis, Vlassis N. (2010). "Women and Cardiovascular Disease." Hellenic J. Cardiol

51: 283-284.

Ridker, Paul M., Nancy R. Cook, I-Min Lee, David Gordon, J. Michael Gaziano, JoAnn

E. Manson, Charles H. Hennekens & Julie E. Buring (2005). "A Randomized

Trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease

in Women." In the New England Journal of Medicine 352: 1293-1304.

Roncalli, Jerome, Meyer Elbaza, Nicolas Dumonteila, Nicolas Boudoua, Olivier Laireza,

Thibault Lhermusiera, Talia Chilona, Cecile Baixasa, Michel Galinier, Jacques

Puela, Jean-Marie Fauvela, Didier Carrie & Jean-Bernard Ruidavetsc (2010).

"Gender disparity in 48-hour mortality is limited to emergency percutaneous coronary intervention for ST-elevation myocardial infarction." In Archives of Cardiovascular Disease 103: 293-301.

Shirato, Susan & Beth Ann Swan (2010). "Women and Cardiovascular Disease: An

Evidentiary Review." In Medsurg Nursing 19: 282-306.

Silva, Gisele, Fabricio O. Lima Erica C.S. Camargo…[continue]

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