Women's Health Matters

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Sex Differences

In May 2009, our guest expert was Dr. Anna Day, director of the Gender and Airways Program at Women’s College Hospital in Toronto.

Dr. Day is also a professor of medicine in the division of respirology at the University of Toronto. She studies gender differences in lung conditions, including asthma and smoking-related lung disease. Dr. Day’s work includes researching the demographics of these conditions, as well as studying gender differences in risk factors, natural history, diagnostics, treatments and outcomes. Her research projects include work on smoking initiation and cessation, chronic obstructive lung disease, asthma and lung cancer screening.

Dr. Day also studies knowledge translation (integrating, exchanging, circulating and ethically applying knowledge) to both doctors and patients on these subjects to improve prevention, early detection of disease, and optimal self-management. She has an ongoing interest in the training of medical students, and is also chair of continuing education for the division of respirology at the University of Toronto.

Here are her answers on Sex Differences.

Q: What are the new frontiers of research with respect to sex and gender differences and health-care outcomes?

A: The new frontiers of sex and gender research focus on the impact of lifestyle on differences in health outcomes. The aspects of lifestyle that are most in need of sex and gender research include smoking, obesity and exercise.

 


Q: I once heard in a presentation that men with asthma who presented to emergency had more severe breathing problems than did women, but were less aware of the severity. Is that true?

A: The statistics are actually the other way around. Women with asthma present to the emergency room twice as often as men with asthma, and are more likely to be admitted because of symptoms that are perceived to be more severe by the women and their physicians.

 



Q: When I saw this month’s Ask the Expert topic I started thinking about the medical school curriculum. Do the medical schools do anything to train medical students about sex differences?

A: The Ontario medical schools have put together a collaborative web-based resource for teaching medical students about sex and gender. This is available at http://www.genderandhealth.ca and faculty members are encouraged to use this in their course design. Some of the medical schools have actually set up courses in sex and gender, but most integrate the information into their regular curricula.

 


Q: I am a physiotherapist who works mainly with seniors in a large urban hospital. What kinds of things should I be doing in my practice to account for the differences between men and women?

A: It is helpful to think about both the biologic and psychosocial differences between senior men and women. For example, elderly men are more likely to still have a partner to assist them, while elderly women tend to be widowed. This has an impact on the availability of physical, psychological and financial supports and may impact the  ability to accept, benefit from and afford physiotherapy. There are conditions that might be more prevalent in older women than in men, such as dementia and osteoporosis. Such differences between senior men and women affect their ability to carry out their activities of daily living, and ultimately affect their quality of life.

 


Q: Why do women live longer than men?

A: The gap between life expectancy for men and women is decreasing, especially as we are making improvements in cardiovascular outcomes for men. It is currently believed that almost all of the gap between women and men would be addressed if smoking were eliminated for both men and women.

 



Q: I heard that women and men react differently to certain medications. What are the reasons? Are there some medications that are OK for men, but women should not take? What about over-the-counter medications? Do I need to review them all with my doctor or pharmacist?

A: There is still little information about differences in reactions to medications by gender, as this is not required for federal approval for drugs. Of course, if you are pregnant you should not be taking any medications without consulting your physician, and if you are on multiple medications your pharmacist should know so that s/he can check for unwanted interactions. Most over-the-counter products, and especially “natural” products, do not have the same amount of testing and quality control as prescription medications and we do not have information regarding men vs. women. If you have concerns about over-the-counter products you should review these with your pharmacist.

 


Q: Is smoking cigarettes potentially more dangerous for women than men? Are women more susceptible to second-hand smoke than men? And are they at increased risk for emphysema?

A: Considerable information is emerging that suggests that women develop Chronic Obstructive Pulmonary Disease (COPD) – which includes emphysema and chronic bronchitis – and lung cancer with less smoking than do men. In fact, the death rates for women from COPD and lung cancer are increasing, whereas those for men are decreasing. This is despite the fact that fewer men and women are smoking. This increases our concern that women are more sensitive to the effects of smoke.

 


Q: After I read the news item on womenshealthmatters.ca that said that men and women get treated differently by paramedics and the medical system when they show up with chest pain, I started to get concerned. What should I do to ensure that I get the best medical treatment?

A: The best way to ensure good care is to know about any conditions that you have or might be at risk for and to have the necessary information readily available to paramedics and the medical system. You should always have a list of your conditions, your medications and contact information in your wallet, and, if appropriate, a MedicAlert bracelet. Fortunately, those working in the health-care system have become much more aware of the alternate presentation of women with heart disease and I suspect that newer studies will show improved care for women with this condition. Our focus now needs to be on other conditions that are missed because of gender stereotyping.

 


Q: Why are women more likely than men to get autoimmune diseases such as lupus and osteoarthritis?

A: We believe that women have more autoimmune diseases because much of the genetic material for these conditions is carried on the X chromosome, and women have two X chromosomes (men have an X and Y). In addition, it may be that female hormones alter the expression of autoimmune genes and make it more likely that they are expressed.

 


Q: Do pediatric sex differences reflect the same issues and conditions as sex differences in adult patients? 

A: Sometimes pediatric sex differences are opposite to adult patients! For example, asthma is much more common in boys and they are hospitalized two to three times as often as girls. However, in adults, women are more likely to have asthma and are hospitalized twice as often as men!! There are other examples of pediatric sex differences that are different in adulthood…children are not just small adults!

 


Q: My doctor wants me to volunteer for a clinical trial on a treatment for diabetes. I heard that fewer women than men volunteer for clinical trials. Do you know why? Are there any risks, specific to women, that I should be aware of if I volunteer for a clinical trial?

A: In the past, women were often excluded from clinical trials because of concerns that they might become pregnant, or that cyclic variations in hormones might cause “abnormal” results. As a consequence, results of studies on men were being inappropriately extrapolated to women. In the U.S. it is now mandated that there must be appropriate representation of women in studies, and recruitment is not a significant problem. As a potential volunteer in a clinical trial, you should ensure that the trial has been approved by a Research Ethics Board of the sponsoring organization. You should read the informed consent carefully and ensure for yourself that you are an appropriate candidate and that you are comfortable with the alternative therapies that you might receive.

 


Q: Can you comment on emerging diagnostic tools to identify heart disease in women? When I attended the Mayo Clinic Science & Leadership Symposium for Women with Heart Disease in October, we learned that many standard cardiac tests (EKG, blood enzymes, the treadmill stress test) have been researched and developed for male patients, and are quite accurate in identifying heart disease in men. However, as we also learned, they are notoriously inaccurate in women, especially for things like single-vessel occlusions or microvascular disease that are more common in women than in men.

Where are we with C-reactive protein testing, calcium scans or any other new diagnostics for women who right now are being misdiagnosed and then sent home from the emergency room having passed the standard tests for heart disease?

A: We continue to have an increasing body of information on women and cardiovascular disease. Women are more likely than men to have microvascular disease which may require nuclear imaging or stress echocardiography and catheterization to diagnose. While there are new modalities being developed for diagnosis of cardiovascular disease such as CRP and calcium scans, there is no information yet regarding the efficacy of these modalities specifically in women.  (Editor’s note:  answer provided by Dr. Len Sternberg, Cardiologist, Women’s College Hospital).

 

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