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Explanatory power of gender relations in cardiovascular outcomes: the missing piece of the puzzle
  1. Valeria Raparelli1,2,
  2. Marco Proietti3,4,
  3. Stefania Basili5
  1. 1 Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
  2. 2 Center for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
  3. 3 IRCCS—Istituto di Ricerche Farmacologiche ‘Mario Negri’, Milan, Italy
  4. 4 Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
  5. 5 Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
  1. Correspondence to Professor Stefania Basili, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome 00144, Italy; stefania.basili{at}uniroma1.it

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The awareness that psychosocial factors play a pivotal role in shaping health goes back to 1948 when WHO defined health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’, even though nowadays, the role that psychosocial factors, commonly defined as gender-related factors, play in the exposure to disease and in their development is still neglected by most researchers and barely explored in clinical trials. The inclusion of gender in clinical data analysis is a powerful opportunity to discover differences in the relationship between exposure and outcomes for men and women, which can inform strategies for intervention.

The understanding of the gender-related social factors as reasons for differences in health outcomes is still an unmet need that requires further evaluation in order to address inequities in access to care and prevention of disease. It has been previously reported how gender can explain or even be the main determinant of adverse clinical outcomes among women and men with premature acute coronary disease.1 However, the scientific community is less sensitive to the integration of gender dimension in trial design. The main issue to handle is the lack of a standardised method to measure the complexities of all that gender encompasses including gender identity, social roles, socioeconomic status and interpersonal relationships (http://www.cihr-irsc.gc.ca/e/49347.html). Gender relations dimension refers to how we interact with or are treated by people in the world around us, based on our ascribed gender: civil status is a gender-related factor that may have a relevant impact on health outcomes. …

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