Term Paper on "Heart Disease Gender Differences"

Term Paper 6 pages (1988 words) Sources: 6 Style: MLA

[EXCERPT] . . . .

Gender Differences in Incidence of Heart Disease

Gender Differences in the Incidence of Heart Disease

Heart disease continues to represent a national health issue, with more men experiencing heart attacks at earlier ages than their female counterparts (Thom, Kannel, Silbershatz and D'Agostino 3). Women, though, continue to be at higher risk for some types of heart disease-related illnesses. For example, more than 50% of all coronary mortalities are the result of sudden cardiac death; furthermore, fully half of men and 64% of women who die suddenly did not have a history of diagnosed coronary artery disease (Wilansky and Willerson 295). Excluding angina, 18% of men with coronary events and 24% of women present with sudden death as the first and only symptom (Wilanksy and Willerson 295). Therefore, identifying relevant biological risk factors associated with heart disease and any gender difference that may reflect the differences in the underlying cardiac pathology or pathophysiology represents a timely investigation today. To this end, this paper provides a review of the peer-reviewed and scholarly literature to identify relevant biological and psychological theories that may account for any differences in the incidence of heart disease among men and women. A summary of the research and salient findings are presented in the conclusion.

Review and Discussion

Biological Differences. By all accounts, there are some important biological differences between men and women that contribute to their respective risk factors for various disease processes. In this regard, Dresser (1992) reports that, "The physiology of women and men differs in ways that can affect how disease and treatment manifest themselves. Beyond the obviously sex-linked diseases such as uterine and prostate cancer, there is evidence that heart disease, AIDS, depression, and numerous other ostensibly 'general-neutral' conditions are expressed differently in women and men" (24). Likewise, as Notman and Nadelson report, "Sexual dimorphism in certain adaptive characteristics is universal in human populations. The unique reproductive capacities of females normally mark their lives by menstruation, pregnancy, parturition, lactation, and menopause. Males are, on the average, larger and have greater physical strength than females in the same population. The burden of evidence also indicates that males are more aggressive..." (3). The clinical studies to date confirm that such a biological link exists as it pertains to heart disease in particular among men and women, but with some important differences. For example, although coronary heart disease represents the major cause of death in both men and women, men are twice as likely to develop coronary heart disease and to die from it at an earlier age (Eisler and Hersen 9). In addition, there are some biological differences in how men and women metabolize cholesterol in ways that contribute to higher incidences of disease among men than women. For instance, Henkel points out that prior to experiencing menopause, women tend to have total cholesterol levels that are lower than men of the same age and the higher cholesterol levels experienced by men of the same age can tend to increase the risk for heart disease (23). Therefore, there is clearly a biological aspect involved in the incidence of heart disease, but there are some equally important psychological processes involved that may serve to exacerbate the risk factors for heart disease, and these issues are discussed further below.

Gender Differences. Just as there are profound biological differences between men and women that may affect their risk of acquiring heart disease, there are some important gender-related factors involved as well. As Notman and Nadelson emphasize, "Recurrent gender differences in child behavior exist across diverse cultures: boys 3-6 years of age exhibit more aggression, particularly rough-and-tumble play, than girls, and girls at that age exhibit more touching behavior. This suggests that males and females are predisposed to divergent behavioral development" (3). In fact, the gender differences in the incidence of heart disease between men and women is more pronounced in the United States than in any other industrialized country today (Courtenay 81). According to this author, "American men, on average, die more than six years younger than American women do. African-American men die nine years younger than African-American women do. Men have higher death rates for all 15 leading causes of death. Men's age-adjusted death rate for heart disease, for example, is two times higher than women's rate" (Courtenay 81). As Krantz and Mcceney (2002) point out the etiology of heart disease involves a series of biochemical, immune-inflammatory, and hemodynamic processes that combine to increase overall risk, but the growing body of evidence concerning coronary heart disease in particular suggests that clinical manifestations may be triggered by various behavioral activities such as exercise, mental stress, sexual activity, and/or during sleep (342). These authors emphasize, though, that it is important to note that because of the complex pathophysiology of coronary disease, various psychosocial and behavioral variables may relate to different aspects of the disease process (Krantz and Mcceney 342). In sum, Krantz and Mcceney suggest that, "To the extent that these biological processes are influenced by psychological factors, they lend credibility to the biologic plausibility of psychological variables as potential risk factors [for coronary heart disease]" (342).

There are also some important differences in how men and women are treated by mainstream healthcare practitioners in the United States as well that may contribute to the existing gender-related differences in the incidence of heart disease. As Benrud and Reddy (1998) point out, "Disparities in the diagnosis and treatment of illness in women and men are particularly evident in heart disease, the leading cause of female and male mortality. For example, women are less likely than men to have physician-ordered diagnostic procedures such as cardiac catheterization and thallium stress tests. When women do receive diagnostic tests (e.g., emergency room electrocardiograms), they usually receive them later than men, resulting in delays in necessary treatments" (375).

Moreover, American men are more likely to receive treatments such as coronary angioplasty and coronary artery bypass surgery than women and in those instances where when women and men present with similar cardiac symptoms, clinicians are more likely to attribute women's symptoms than men's to psychiatric and other noncardiac causes (Benrud and Reddy 375). These authors emphasize that, "This latter finding, in particular, suggests that disparities in the diagnosis and treatment of illness in women and men may reflect, in part, psychosocial factors such as an androcentric bias to attribute illness symptoms in women to emotional rather than physical causes" (Benrud and Reddy 375).

Finally, American men are also more likely to engage in a number of behaviors that may increase their risk of heart disease, including drinking excessive amounts of alcohol or abusing alcohol more so than their female counterparts, behaviors which can lead to additional stress and heart-related disease processes (Krohn and Pyc 459). According to Eisler and Hersen, "Community studies consistently find that older men drink alcohol more frequently and in greater quantity than older women. Additionally, males have higher rates of diagnosable alcohol problems, typically at about the rate of 3 to 5 times more prevalent. These strong gender differences are possibly due to social norms: Use of alcohol is more acceptable for men; women drinkers may consequently keep the problem hidden" (423).

Discussion and Critique. One of the more interesting issues to emerge from the research concerned the dearth of timely studies concerning gender differences as they relate to various disease processes that provided a completely subjective analysis. Virtually every study concerning gender differences in this regard was shown to have some type of constraint or limitation that precluded its generalization across the board for both men and women because of the manner in which the studies to date have been conducted or how the findings have been interpreted (Feingold 91). Because gender differences relate to those aspects of the social environment that serve to contribute to how individuals perceive themselves as being "boys" or "girls," it is reasonable to assert that there is some degree of personal free will involved in making the decision to engage in those behaviors that may adversely affect an individual's health. In this regard, Callahan (2000) emphasizes, unlike the biological factors that may contribute to a higher risk of acquiring heart disease, some gender factors are controllable: "Gender differences can be either accentuated or minimized in comparison to other individual differences and commonalities between the sexes" (9).

Indeed, even if society says it is "okay" for "manly" men to drink a lot, smoke cigarettes and chase women outside of marriage, these behaviors may not be particularly conducive to the promotion of good health. Likewise, to the extent that American society emphasizes the nurturing aspects of the female condition may be the extent to which women continue to engage in those behaviors that may help them avoid heart disease. For example, American women have traditionally been viewed as the caregivers of the family, and while this has changed in substantive ways in recent decades, this view of femininity may encourage some women to avoid confrontations and behave in a meeker fashion than their male counterparts. These are… READ MORE

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