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Sex and gender matter in cardiovascular disease and beyond
  1. Sanne A E Peters1,2,
  2. Mark Woodward3
  1. 1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2 The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
  3. 3 The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Sanne A E Peters, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; speters{at}

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Sex and gender are fundamental drivers of virtually all major causes of death and disease, while gender equality has been shown to improve the health of both women and men at the population level. The term ‘sex’ is generally used to describe biological characteristics, while ‘gender’ is used to address social constructs. Sex and gender are intertwined and interconnect with other key drivers of health, such as age, socioeconomic position, race and ethnicity.

Over the past decade, many clinically meaningful sex differences in several aspects of cardiovascular disease (CVD) have been uncovered. Although the lifetime risks are similar when women’s longer life expectancy is considered, CVD develops about 5–10 years earlier in men. The first manifestation of CVD is also different between sexes; women are more likely to have stroke as their first event, while men are more likely to have coronary heart disease (CHD). Presenting symptoms of CHD and stroke can also be different between women and men, which may undermine timely diagnosis and management. Furthermore, although current guidelines for prevention of CVD do not generally differentiate between women and men, women often receive inferior treatments. Also, while the key modifiable risk factors for CVD are the same for women and men, including high blood pressure, smoking, high cholesterol, obesity and diabetes, there are some notable sex differences in the magnitude of the adverse effects conferred by these risk factors.1 For example, while diabetes is a strong risk factor for myocardial infarction (MI) in both women and men, the magnitude of the excess risk of MI conferred by diabetes is almost 50% greater in women than in men. Similarly, current smoking, as compared with never, is associated with a 55% greater excess risk of MI in women than …

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  • Contributors SAEP wrote the first draft. MW provided critical feedback. Both authors agreed with the submission of the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MW is a consultant to Amgen, Freeline and Kyowa Hakko Kirin.

  • Provenance and peer review Commissioned; externally peer reviewed.

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