Why do men get more heart disease than women? An international perspective

Biological, behavioral, and psychosocial contributions to the gender gap in coronary heart disease (CHD) are discussed. Although CHD is the Number 1 cause of death for both sexes in the industrialized world, CHD mortality rates between these countries are larger than those between men and women, suggesting that biological factors are not the sole influences on the gender gap in CHD. Traditional coronary risk factors cannot explain the rapid increase in CHD mortality among middle-aged men in many of the newly independent states of eastern Europe. However, eastern European men score higher on stress-related psychosocial coronary risk factors (e.g., social isolation, vital exhaustion) than men living in the West. Comparisons between the sexes also reveal gender differences in psychosocial and behavioral coronary risk factors, including excessive alcohol consumption and smoking, favoring women. Overall, it appears that men's coping with stressful events may be less adaptive physiologically, behaviorally, and emotionally, contributing to their increased risk for CHD.     

Results of a Heart Disease Risk-Factor Screening Among Traditional College Students

Abstract

Biological, behavioral, and psychosocial contributions to the gender gap in coronary heart disease (CHD) are discussed. Although CHD is the Number 1 cause of death for both sexes in the industrialized world, CHD mortality rates between these countries are larger than those between men and women, suggesting that biological factors are not the sole influences on the gender gap in CHD. Traditional coronary risk factors cannot explain the rapid increase in CHD mortality among middle-aged men in many of the newly independent states of eastern Europe. However, eastern European men score higher on stress-related psychosocial coronary risk factors (eg, social isolation, vital exhaustion) than men living in the West. Comparisons between the sexes also reveal gender differences in psychosocial and behavioral coronary risk factors, including excessive alcohol consumption and smoking, favoring women. Overall, it appears that men's coping with stressful events may be less adaptive physiologically, behaviorally, and emotionally, contributing to their increased risk for CHD.     

Heart disease risk perception in college men and women

The authors sought to assess the perception of risks for coronary heart disease (CHD) in college men and women. They surveyed 470 undergraduates from 2 major 4-year institutions who completed a questionnaire that measured perceived risks for heart disease. Sixty-eight percent of the respondents rated their risks as lower or much lower than those of their peers, indicating a clear optimistic bias. The research also revealed that the students who exercised regularly rated their risk of coronary disease lower than those who did not do so. In addition, women perceived a number of risk markers to be more potent or causative factors than men did. A significant number of participants did not comprehend commonly understood causal relationships associated with heart disease risk. The findings in this preliminary investigation suggest that college men and women do not accurately perceive their risks for developing heart disease.     

Heart Disease Risk Perception in College Men and Women

Abstract

The authors sought to assess the perception of risks for coronary heart disease (CHD) in college men and women. They surveyed 470 undergraduates from 2 major 4-year institutions who completed a questionnaire that measured perceived risks for heart disease. Sixty-eight percent of the respondents rated their risks as lower or much lower than those of their peers, indicating a clear optimistic bias. The research also revealed that the students who exercised regularly rated their risk of coronary disease lower than those who did not do so. In addition, women perceived a number of risk markers to be more potent or causative factors than men did. A significant number of participants did not comprehend commonly understood causal relationships associated with heart disease risk. The findings in this preliminary investigation suggest that college men and women do not accurately perceive their risks for developing heart disease.     

Treating cardiovascular disease in women

Cardiovascular disease (CVD) is the most common cause of death in women but some of the challenges of management differ from those in men. This article addresses the gender-specific issues of cardiovascular management, with emphasis on ischaemic heart disease and modification of coronary risk factors. Women with ischaemic heart disease present later than men, and are therefore older and more likely to suffer from co-morbidities such as diabetes and hypertension. Proven CVD risk factors in women can be divided into those that are modifiable and those that are non-modifiable. The former include diabetes, dyslipidaemia, hypertension, smoking, obesity, sedentary lifestyle and poor nutrition; the latter include family history of heart disease and older age at presentation. It is this difference in age and general health that explains much of the variability in response to treatment. Pharmacotherapy, percutaneous intervention, surgical revascularization, and cardiac rehabilitation and disease prevention are discussed.     

Health Differences Between Married Men and Women: The Contribution of Sex-Role Stereotyping

Compared with married men, married women are nearly twice as likely to suffer from psychiatric disorder, although they have only half the annual mortality rate until about age 75, and their life expectancy is nearly 7 years greater. It is argued that sex-role stereotyping contributes substantially to these major health differences between men and women. Some contemporary social and psychological factors that reinforce sex-role stereotyping are discussed, together with some proposals for countering these.     

Sharing Health Services: Two Universities,a Seminary,and a Community

Abstract

“The Inverse Relation Between Fish Consumption and 20-Year Mortality From Coronary Heart Disease,” DAAN KROMHOUT, et al. The low death rate from coronary heart disease among the Greenland Eskimos has been ascribed to their high fish consumption. We therefore decided to investigate the relation between fish consumption and coronary heart disease in a group of men in the town of Zutphen, the Netherlands. Information about the fish consumption of 852 middle-aged men without coronary heart disease was collected in 1960 by a careful dietary history obtained from the participants and their wives. During 20 years of follow-up 78 men died from coronary heart disease. An inverse dose-response relation was observed between fish consumption in 1960 and death from coronary heart disease during 20 years of follow-up. This relation persisted after multiple logistic-regression analyses. Mortality from coronary heart disease was more than 50 per cent lower among those who consumed at least 30g of fish per day than among those who did not eat fish.

We conclude that the consumption of as little as one or two fish dishes per week may be of preventive value in relation to coronary heart disease. (New England Journal of Medicine 1985;312:1205–9.)

“Teaching Touch at Medical School,” JULES OLDER. The association between touch and healing is ancient and worldwide. Skilled hands are among the physician's most important diagnostic and therapeutic tools. Yet a survey of medical schools in the English-speaking world revealed that most offer no touch training in their curricula. Of 169 medical schools, only 12 give any formal instruction in the uses and meaning of therapeutic touch in medicine. The teaching modes of these 12 schools are discussed, and the program of the most touch-conscious school, the University of Otago, is described. (Journal of the American Medical Association 1984;252:931–3.)

“Tubal Infertility and the Intrauterine Device,” DANIEL W. CRAMER, et al. To study the association between intrauterine devices (IUDs) and pelvic inflammatory disease, we compared contraceptive histories in 4185 white women—283 nulliparous women with primary tubal infertility, 69 women with secondary tubal infertility, and 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with IUD use was calculated by means of multivariate logistic regression to control for confounding factors, including region, year of menarche, religion, education, smoking, and reported number of sexual partners. The adjusted risk of primary tubal infertility associated with any IUD use before a first live birth was 2.0 (95 per cent confidence limits, 1.5 to 2.6) relative to nonuse. Users of the Dalkon Shield had an adjusted risk of 3.3 (1.7 to 6.1), users of the Lippes Loop or Saf-T-Coil had a risk of 2.9 (1.7 to 5.2), and users of copper IUDs had a risk of 1.6 (1.1 to 2.4). Women who reported having only one sexual partner had no increased risk of primary tubal infertility associated with IUD use. The adjusted risk of secondary tubal infertility associated with use of a copper IUD after a first live birth was not statistically significant (1.5; 95 per cent confidence limits, 0.8 to 3.0), whereas the risk from similar use of noncopper devices was significant (2.8; 1.3 to 5.9). We conclude that tubal infertility is associated with IUD use, but less so with copper IUDs. (New England Journal of Medicine 1985;312:941–7.)     

The relationship between plasma androgens (dehydroepiandrosterone sulfate and testosterone), insulin,coagulation and fibrinolytic factors in men with coronary arteriosclerosis

Thrombosis plays an important role in the pathogenesis of myocardial infarction and stroke. It is known that a decrease in estradiol plasma concentration in postmenopausal women results in an increase in fibrinogen, plasminogen activator inhibitor (PAI) and tissue-type plasminogen activator (tPA) concentrations, whereas estradiol replacement therapy decreases the plasma concentrations of these factors. In men, the risk of developing myocardial infarction is higher than in premenopausal women. However, the role of male sex hormones in the pathogenesis of arteriosclerosis, although the subject of many studies, has not yet been elucidated. The aim of this study was to determine the plasma levels of and correlation between androgens, insulin, coagulation and fibrinolytic factors in men with coronary arteriosclerosis with and without a history of myocardial infarction. The study was carried out in a group of 109 non-obese men, aged 28-60 years, with coronary artery disease demonstrated by coronary angiography. In this group, 64 men had a history of one myocardial infarction and ten reported two or more such episodes. The control group consisted of 14 volunteers, who were healthy men aged 39-63 years with normal body weight. In men with coronary arteriosclerosis, the plasma levels of dehydroepiandrosterone sulfate (DHEAS) and testosterone were lower, whilst insulin, fibrinogen, PAI, PAI activity and lipoprotein(a) were higher in comparison with the group of healthy controls. We found that, in men with coronary arteriosclerosis, those with the highest incidence of infarction demonstrated the most advanced hyper-insulinism, had lower levels of DHEAS and testosterone, the highest fibrinogen plasma concentrations, as well as PAI-1, tPA and PAI activity. A positive correlation between insulin, PAI-1, tPA and fibrinogen has been shown. In conclusion, low androgen and high insulin concentrations, high PAI-1 and PAI activity, high tPA and fibrinogen concentration may be prognostic indicators of myocardial infarction in men with arteriosclerosis.     

Coronary Risk Factors in Jerusalem Medical Students

Abstract

Thirty-nine male and 25 female Jerusalem medical students participated in a class exercise to determine their own risk factors for coronary heart disease. Systolic and diastolic blood pressures, body-mass index, and proportion of smokers were all lower in females and gave them a significantly lower estimated coronary heart disease (CHD) risk function. There was no sex difference for measures of serum cholesterol. A comparison of the Israeli data with those from three studies of American medical students revealed that Israelis smoke more than their American counterparts but otherwise appear to have similar risk profiles. The authors felt that the exercise was useful in helping these soon-to-be physicians understand the significance of the concepts of risk factors and risk and hope it will induce some of them to improve their own modifiable risk factors.     

Androgens, apoE, and Alzheimer's disease

Increasing evidence indicates that there are reductions in estrogen and androgen levels in aged men and women. These hormonal reductions might be risk factors for cognitive impairments and the development of Alzheimer's disease (AD). Aged people show improved cognition after treatments with sex steroids. Therefore, ongoing clinical AD trials have been designed to evaluate the potential benefits of estrogen therapy in women and testosterone therapy in men. Apolipoprotein E (apoE) plays an important role in the metabolism and redistribution of lipoproteins and cholesterol. The three major human apoE isoforms, apoE2, apoE3, and apoE4, differ in their effects on AD risk and pathology. Here I review various mechanisms proposed to mediate the differential effects of apoE isoforms on brain function and highlight the potential contribution of detrimental isoform-dependent effects of apoE on androgen- and androgen receptor (AR)-mediated pathways. I also discuss potential interactions of androgens with other AD-related factors.     

Eating Disorders and Body Image Concerns Among Male Athletes

Many men are as obsessed as women with counting calories. They are preoccupied with their weight, diet frequently, exercise excessively, and binge and purge. Some subgroups of men have eating disorder rates higher than those of the general male population. One subgroup consists of men who participate in competitive athletics. Although there is increasing awareness of eating disorders in men, male athletes may continue to elude identification and be difficult to treat. Their subculture promotes the use of unhealthy measures, such as restrictive eating, binging and purging, and consuming steroids and other performance enhancing drugs. Professionals involved with the male athlete may not recognize these behaviors as problematic. In fact, they may not even look for the behaviors when dealing with men. Consequently, men’s eating disorders are missed and misdiagnosed. Male athletes face a combination of cultural, political, and financial pressures that is unique and represents an added risk factor that could have long-term irreversible effects. It is imperative that mental health professionals be aware of the unique-to-men risk factors associated with disordered eating. This article illustrates how eating disorders as well as body image dissatisfaction manifest themselves in male athletes, how difficult it can be to engage them in psychotherapy, and how clinicians can address these concerns.     

Women at Risk for Human Immunodeficiency Virus

This article reports results from a survey among women at risk for contracting human immunodeficiency virus (HIV) as well as transmitting it in a vertical (to offspring) and horizontal (sexual partner or intravenous [IV] drug usage) mode. Little is known about the extent of HIV knowledge, sexual behaviors and IV drug usage for women at risk for HIV infection. The sample (N = 620) consisted of Black (50.6%), Caucasian (28.7%), Hispanic (13.4%) and Haitian (5.0%) adult non-pregnant women from South Florida. Data concerning their drug usage, sexual behaviors and other risk factors for HIV infection are presented alone with their knowledge about HIV infection and acquired immunodeficiency syndrome (AIDS). The women had an adequate knowledge base about HIV and AIDS; however the results indicated that our sample was at risk due to the following risk factors: (1) unprotected sexual intercourse, both vaginal and anal, with men who were at high risk for HIV infection (i.e., men who were bisexual and/or used IV drugs); (2) IV drug usage by the woman themselves including needle sharing in "shooting galleries"; (3) the practice of prostitution by the women and; (4) the use of various non-IV drugs that have been shown to impair judgement and lower inhibitions regarding sexual practices. Results indicate differences in risk behaviors and knowledge about AIDS by race/ethnicity.     

Osteoporosis in the aging population: the male perspective

The importance of senile osteoporosis in men as a public health problem has long been underestimated. Elderly men are at substantial risk for fracture, and morbidity after osteoporotic fractures appears to be more serious and mortality more common in men than in women. Risk factors for osteoporotic fractures in men appear to be qualitatively similar to those in women, but there are quantitative differences. Low bone mineral density (BMD) is an important risk factor for fracture in men; however, further clarification of the relationship between BMD, bone geometry and fracture risk is needed before formulating definitive proposals on operational densitometric criteria for diagnosis of osteoporosis in men and the identification of men at high risk for fracture. Understanding of the mechanisms underlying senile bone loss and the pathogenesis of senile osteoporosis in men remains fragmentary with, in particular, the need for further clarification regarding the precise impact of hormonal status in elderly men on skeletal homeostasis. Recommendations on prevention and treatment of senile osteoporosis in men should focus on the minimization of known risk factors for bone loss and falls. Testosterone treatment may be useful in those men with initially low serum testosterone. As to other pharmacological treatment modalities, prospective trials specifically in elderly men, and preferably with fracture incidence as the primary clinical endpoint, are required.     

The impact of touch-tone data entry on reports of HIV and STD risk behaviors in telephone interviews

Respondents concerns about privacy can decrease reporting of HIV and STD risk behaviors in general population telephone surveys. The purpose of this paper is to describe the results of an experimental study evaluating whether one method for increasing privacy, touch-tone data entry (TTDE), is effective in increasing estimates of sexual behaviors from a population-based survey. We conducted a random-digit-dial telephone survey of adults in New Jersey (n = 405), with half the respondents using TTDE for answering sexual behavior questions. TTDE led to increased reports of same-sex sexual behavior, certain HIV and STD risk factors, and concern about one s risk for HIV and STD transmission. TTDE also narrowed the difference between men s and women s reports of the number of different sexual partners over the past 10 years. The feasibility and limitations of TTDE are discussed, as well as possible alternative interpretations that consider the impact of TTDE on the dynamics of the interaction between the respondent and the interviewer.     

‘Live to Work’ or ‘Work to Live’? A Qualitative Study of Gender and Work–life Balance among Men and Women in Mid‐life

Many contemporary studies of ‘work–life balance’ either ignore gender or take it for granted. We conducted semi‐structured interviews with men and women in mid‐life (aged 50 to 52 years) in order to compare their experiences of work–life balance. Our data suggest that gender remains embedded in the ways that respondents negotiate home and work life. The women discussed their current problems juggling a variety of roles (despite having no young children at home), while men confined their discussion of such conflicts to the past, when their children were young. However, diversity among men (some of whom ‘worked to live’ while others ‘lived to work’) and women (some of whom constructed themselves in relation to their families, while others positioned themselves as ‘independent women’) was apparent, as were some commonalities between men and women (both men and women constructed themselves as ‘pragmatic workers’). We suggest ways in which gender‐neutral theories of work–life balance may be extended.     

Difference in Condom Use Among Sexually Active Males at Historically Black Colleges and Universities

Black men who have sex with men (MSM) and black men who have sex with both men and women (MSMW) may not perceive themselves to be part of the larger gay community and hence may not heed prevention messages aimed at the community. Objective and Participants: To better understand the participants behaviors, the authors examined differences in condom use between black MSM/W (including MSM and MSMW) and men who have sex with women (MSW) at historically black colleges and universities (HBCUs). Methods: A paper-and-pencil questionnaire survey investigated sexual behaviors of 1,865 freshmen from 35 HBCUs during the 2001-2002 school year. Results: MSM/W were about 0.37 times less likely to always use condoms compared with MSW (adjusted odds ratio = 0.63, 95% confidence interval = 0.42-0.95). Sexual behavior, age at survey, total family income, and religion were also associated with condom use. Conclusions: These findings offer new directions for sexually transmitted disease and HIV prevention aimed at a highly marginalized population that remains at high risk for infection.     

Gender Differences in Personal Income and Financial Risk Tolerance: How Much of a Connection?

Prior research indicates that relative to men, women generally have lower incomes and typically are more risk averse. In a sample of the clientele of financial planners, men had higher personal incomes and exhibited greater financial risk tolerance, which is consistent with previous studies. The authors' objective was to determine how much of the gender difference in income could be explained by risk tolerance. Results indicate that risk tolerance can explain some of the variation in earnings between women and men but that it is not a primary reason for the wage gap.     

Heart disease and gender in mass print media

Heart disease is a major cause of death, disease and disability in the developed world for both men and women. Nevertheless, the evidence suggests that women are under-diagnosed both because they fail to visit the doctor with relevant symptoms and because doctors tend to dismiss the seriousness of women's symptoms of heart disease. This study examines the way that popular mass print media present the possible links between gender and heart disease. The findings suggest that the 'usual candidates' for heart disease are considered to be high achieving and active men for whom the 'heart attack' is sometimes seen as a 'badge of honour' and a symbol of their success. In contrast, women are less often seen as likely to succumb, but they are portrayed as if they are and ought to be worried about their husbands. Women's own bodies are described as so problematic as to be perhaps useless to diagnose, because they are so difficult to understand and treat.     

Trial and lifetime smoking risks among African American college students

The authors surveyed 614 African American university students to determine the magnitude of cigarette use, identify risk factors, and develop models to predict smoking. More than half (58.3%) of the participants had smoked at least once, and 9.3% of that group were lifetime smokers. Among the lifetime smokers, 71.3% had smoked during the 30 days preceding the survey. More women (66.8%) than men (56.1%) had tried smoking and were classed as lifetime smokers. Residence, parental, and peer smoking (current and childhood) were associated with trying smoking; age, race/ethnicity, and marital status were additional factors for becoming a lifetime smoker. The risk of being a lifetime smoker was reduced when neither friends nor parents of the student smoked and the student viewed spirituality as important. The results of this study add to the growing understanding of health risk behaviors among African Americans and can be useful in reducing smoking.