Temilolaoluwa Daramola, MS4
One
in every three deaths within the United States is associated with
cardiovascular diseases with women increasingly closing the difference in rates
between their male counterparts. More focus has been on the physiologic impact
of estrogen on cardiac function over the lifecycle of women. While more studies
are now increasingly recruiting female participation in studying cardiovascular
diseases, it remains the leading cause of death in this group. Additionally,
there is a 9-year delayed onset of a heart attack in women compared to men that
is narrowing. Therefore, a complementary point of view and a deeper dive must
be done to highlight the relationship between gender inequities and heart
disease.
Unlike
sex ascription which focuses primarily on the biological characteristics,
gender is a social construct thwarted by some biological contexts. Therefore,
gender should be viewed as a social determinant of health. Understanding the
mechanism of early socialization into the gender roles during child development
could help highlight some of the high-risk behaviors that result in a
deleterious effect on cardiovascular disease among women during adulthood.
Physical
fitness is typically emphasized to boys compared to emotional and verbal skills
that are inculcated into girls. While parental styles may help modulate the
degree of conformity to these values, studies have noted that girls at the age
of 6-8 are more sedentary than boys. These early childhood behaviors increase
the risk of transferring such traits into the adolescent age. Additionally,
women are reported to be less likely to exercise in public spaces at night or
through the cities due to safety issues.
While cigarette smoking used to be
previously linked to boys, this has changed to be an equally high-risk factor
of girls as well. A behavior that begins most critically during adolescence has
a lasting impact during adulthood. Furthermore, girls are more likely to learn
this behavior from parental influence compared to boys whereby their scope of
influence is with their peers. Specifically, females that start smoking at
greater than 16 years of age are more likely to develop heart disease and high
blood pressure. Cigarette smoking is also more likely to be adopted by women
for weight loss and body disturbances, especially in a society that places a
high degree of emphasis on the esthetic values of body image in women.
Adverse
childhood events specifically related to trauma can result in chronic stressors;
this negatively affects heart health due to increased autonomic and endocrine
response. More specifically, female victims of intimate partners violence, who
are younger than 25 years of age have been associated with traditional risk
factors that negatively impacts heart disease such as obesity, low high-density
lipoproteins, high low-density lipoproteins and substance use disorder. Additionally,
workplace harassment can be associated with eroding heart health, with 33% of
women more likely to report sexual harassment compared to 9% of men in the
workplace. The added responsibilities of working women having competing
obligations between their professional and domestic role, specifically as
caregivers has been identified as an independent factor that can increase the
incidence of non-fatal chronic heart disease in this group.
Modifying
these risk factors through the process of deconstructing socialized behaviors
that negatively impact women can help lower the rates of heart diseases. Also
paying special attention to these factors before adulthood in early child
development allows for targeted behavioral changes during those critical
periods of life before it becomes more difficult to curb. School based policy interventions
that emphasize increased participation and normalizes equal gender
representation in different sports and gym activities can continue to promote a
physically active lifestyle that is not transient. Secondly, more local
government safety measures should be enacted to create more public spaces in
the city and at night for individuals to feel more comfortable exercising.
Thirdly, engaging family members in smoking cessation conversations can utilize
role-modeling to positively augment teenage-acquired habits. On a more upstream
level additional focus should emphasize policies that promote gender equality
within the workspace and financial independence through extensive day care
services, combined couple paid leaves and scrutinize workplace harassment,
which further positively augments those effects on women’s health.
These
behaviors have physiological implications that is vital to focus on. Therefore,
viewing gender through a social and biological lens provides a more
comprehensive approach to decreasing cardiovascular disease burden and
disparities related to this.
Sources:
·
McLean
CP, Anderson ERBrave men and timid women? A review of the gender differences
in fear and anxiety.Clin Psychol Rev. 2009; 29:496–505.
doi: 10.1016/j.cpr.2009.05.003
·
Lampinen EK, Eloranta AM, Haapala EA, Lindi
V, Väistö J, Lintu N, Karjalainen P, Kukkonen-Harjula K, Laaksonen D, Lakka TAPhysical activity,
sedentary behaviour, and socioeconomic status among Finnish girls and boys aged
6-8 years.Eur
J Sport Sci. 2017; 17:462–472. doi: 10.1080/17461391.2017.1294619
·
Kimm SY, Glynn NW, Kriska AM, Barton BA,
Kronsberg SS, Daniels SR, Crawford PB, Sabry ZI, Liu KDecline in
physical activity in black girls and white girls during adolescence.N Engl J Med. 2002; 347:709–715.
doi: 10.1056/NEJMoa003277
·
Wesely JK, Gaarder EThe gendered
“nature” of the urban outdoors: women negotiating fear of violence.Gender Soc. 2004; 18:645–663.
·
Aldred R, Dales JDiversifying and
normalising cycling in London, UK: an exploratory study on the influence of
infrastructure.J Trans Health. 2017; 4:348–362
·
Thompson AB, Tebes JK, McKee SAGender differences
in age of smoking initiation and its association with health. Addict Res Theory. 2015; 23:413–420. doi: 10.3109/16066359.2015.1022159
·
Cawley J, Markowitz S, Tauras JObesity, cigarette
prices, youth access laws and adolescent smoking initiation. Eastern Econ J. 2006; 32:149–170.
·
Stene LE, Jacobsen GW, Dyb G, Tverdal A,
Schei BIntimate
partner violence and cardiovascular risk in women: a population-based cohort
study.J
Womens Health (Larchmt). 2013; 22:250–258. doi:
10.1089/jwh.2012.3920.
·
Australian Human Rights
Commission. Working Without Fear:
Results of the National Sexual Harassment Survey 2012. https://www.humanrights.gov.au/sites/default/files/content/sexualharassment/survey/SHSR_2012%20Web%20Version%20Final.pdf. ISBN 978-1-921449-37-6. Accessed March 2, 2017
·
Revenson TA, Griva K, Luszczynska A, Morrison
V, Panagopoulou E, Vilchinsky N, Hagedoorn MGender and
caregiving: the costs of caregiving for women.In: Caregiving in the Illness
Context. London, United Kingdom:Springer; 2016:48–63.
·
Lyons JG, Cauley JA, Fredman LThe effect of
transitions in caregiving status and intensity on perceived stress among 992
female caregivers and noncaregivers. J Gerontol A Biol Sci Med Sci. 2015; 70:1018–1023.
doi: 10.1093/gerona/glv001.
·
O'Neil, A., Scoville, A., Milner, A., &
Kavanagh, A. (2018). Gender/Sex as a Social Determinant of Cardiovascular Risk.
Circulation, 137(8), 854-864.
doi:10.1161/CIRCULATIONAHA.117.028595
·
Westerman S, Wenger NK.
Women and heart disease, the underrecognized burden: sex differences, biases,
and unmet clinical and research challenges. Clin Sci. (2016) 130:551–63.
10.1042/CS20150586
