Including gender differences in research and clinical practice saves lives

Over time, we have learned that men and women can be affected differently by certain diseases and do not always respond the same way to treatments. 

When we started the Center for Gender Medicine at Karolinska Institutet and Karolinska University Hospital nearly 25 years ago, it was with the goal of including biological and social gender aspects in both research and practice. 

The initiative was born out of my own experiences as a cardiologist in the cardiac intensive care unit, where I saw that female patients often received poorer care than male patients.

A male disease

At that time, heart attacks were considered to primarily affect men, and the cardiovascular studies conducted mainly included male patients. Therefore, the diagnosis was also based on men's symptoms.

But women often showed different symptoms than men. Instead of blockages in the central coronary arteries (stenosis), they often had problems in peripheral vessels, which could not be seen with traditional coronary angiography. Women were also more likely to have spasms or bleeding in the coronary arteries (SCAD).

These differences led to women's heart problems often being misunderstood or dismissed as hypochondria, even though both ECG and blood tests indicated a heart attack. Some were even referred to psychiatry. However, heart attacks were still the most common cause of death for both men and women.

Increased knowledge 

Much has happened in the cardiovascular field in recent years, and women with heart attacks are no longer at the same risk of being overlooked.

Research has confirmed that heart attacks can be due to pathological changes in the periphery of the heart. It has also been found that women suffer heart attacks 8-10 years later than men, and one theory is that women are protected by estrogen. Also, conditions related to female reproduction, such as preeclampsia, gestational diabetes, polycystic ovary syndrome, and endometriosis, can be linked to future cardiovascular diseases.

Further, women are no longer considered a "special group" in the European guidelines for the treatment of ischemic heart disease as it was earlier. Now they are included in the main group. Also, large clinical trials often include sex and gender analysis of results nowadays.

A crucial perspective in many medical fields

Sex and gender differences are important not only in the cardiovascular field. In most medical specialties, there are significant differences between the sexes that must be considered, and it is gratifying to see that awareness of this has increased in recent years. It is also positive that major Swedish funding bodies, such as the Swedish Research Council and Forte, have adopted the requirement that a sex and gender perspective should be included in applications if relevant.

It would therefore be catastrophic if the attitudes now spreading were to take hold in Europe. Stopping research on sex and gender in medicine risks leading to deaths and suffering among our patients. We must stand up for free research and ensure that gender differences are always considered in medical research and clinical practice.