Consideration of Sex Differences in Medicine to Improve Health Care and Patient Outcomes

Legato, Marianne J.; Johnson, Paula A.; Manson, JoAnn E.

doi:10.1001/jama.2016.13995

Cited by 142 publications

(100 citation statements)

References 11 publications

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“…The identity and impact of such additional factors (including genetic, epigenetic, life-style, and phenotypic traits) deserve further investigation. Particularly, a growing body of evidence demonstrated that a factor such as an individual’s sex can modulate disease phenotype and drug response [11], thus substantially contributing to clinical heterogeneity. In AD patients, sex differences have been reported in the rate of cognitive deterioration [12, 13] and brain atrophy [14], in the absence of clear differences in amyloid or tau burden [15].…”

Section: Introductionmentioning

confidence: 99%

Revolution of Alzheimer Precision Neurology. Passageway of Systems Biology and Neurophysiology

Hampel

Toschi

Babiloni

et al. 2018

JAD

131

113

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The Precision Neurology development process implements systems theory with system biology and neurophysiology in a parallel, bidirectional research path: a combined hypothesis-driven investigation of systems dysfunction within distinct molecular, cellular and large-scale neural network systems in both animal models as well as through tests for the usefulness of these candidate dynamic systems biomarkers in different diseases and subgroups at different stages of pathophysiological progression. This translational research path is paralleled by an “omics”-based, hypothesis-free, exploratory research pathway, which will collect multimodal data from progressing asymptomatic, preclinical and clinical neurodegenerative disease (ND) populations, within the wide continuous biological and clinical spectrum of ND, applying high-throughput and high-content technologies combined with powerful computational and statistical modeling tools, aimed at identifying novel dysfunctional systems and predictive marker signatures associated with ND. The goals are to identify common biological denominators or differentiating classifiers across the continuum of ND during detectable stages of pathophysiological progression, characterize systems-based intermediate endophenotypes, validate multi-modal novel diagnostic systems biomarkers, and advance clinical intervention trial designs by utilizing systems-based intermediate endophenotypes and candidate surrogate markers. Achieving these goals is key to the ultimate development of early and effective individualized treatment of ND, such as Alzheimer’s disease (AD). The Alzheimer Precision Medicine Initiative (APMI) and cohort program (APMI-CP), as well as the Paris based core of the Sorbonne University Clinical Research Group “Alzheimer Precision Medicine” (GRC-APM) were recently launched to facilitate the passageway from conventional clinical diagnostic and drug development towards breakthrough innovation based on the investigation of the comprehensive biological nature of aging individuals. The APMI movement is gaining momentum to systematically apply both systems neurophysiology and systems biology in exploratory translational neuroscience research on ND.

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Section: Introductionmentioning

confidence: 99%

Revolution of Alzheimer Precision Neurology. Passageway of Systems Biology and Neurophysiology

Hampel

Toschi

Babiloni

et al. 2018

JAD

131

113

View full text Add to dashboard Cite

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“…In particular, there are limited data on the role of biological sex in determining psychotropic medication utilization patterns in older people with cognitive impairment. However, sex is an important factor to consider in clinical practice as it can influence healthcare, the choice of pharmacological treatments, and patient outcomes [9, 10]. Disability and morbidity are more prevalent in older women than men; therefore, this may explain why older women are more likely to use more medications overall [11].…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Sex Differences in Psychotropic Medication Use in Older People with Alzheimer’s Disease in the US and Finland

et al. 2016

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Aims Given the high prevalence of psychotropic medication use in people with dementia and the potential for different prescribing practices in men and women, our study aimed to investigate sex differences in psychotropic medication use in older adults with Alzheimer's disease (AD) living in the US and Finland. Methods We used data collected between 2005 and 2011 as part of the National Alzheimer's Coordinating Center (NACC) in the US, and Medication use and Alzheimer's disease (MEDALZ) cohorts in Finland. We evaluated psychotropic medication use (antidepressant, antipsychotic, anxiolytic, sedative, or hypnotic) in participants aged 65 years or older. We employed multivariable logistic regression adjusted for demographics, co-morbidities, and other medications to estimate the magnitude of the association (adjusted odds ratio [aOR] with 95% confidence intervals [CIs]) according to sex. Results We included 1099 NACC participants (502 [45.68%] men, 597 [54.32%] women), and 67,049 participants from the MEDALZ cohort (22,961 [34.24%] men, 44,088 [65.75%] women). Women were more likely than men to use psychotropic medications: US, 46.2% vs. 33.1%, p < 0.001; Finland, 45.3% vs. 36.1%, p < 0.001; aOR was 2.06 (95% CI 1.58–2.70) in the US cohort and 1.38 (95% CI 1.33–1.43) in the Finnish cohort. Similarly, of the different psychotropic medications, women were more likely to use antidepressants (aOR-US: 2.16 [1.44–3.25], Finland: 1.52 [1.45–1.58]) and anxiolytics (aOR-US: 2.16 [1.83–3.96], Finland: 1.17 [1.13-1.23]) than men. Conclusionl Older women with AD are more likely to use psychotropic medications than older men, regardless of study population and country. Approaches to mitigate psychotropic medication use need to consider different prescribing habits observed in older women vs. men with AD.

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“…If one needs further evidence that women are physiologically different than men, randomized controlled trials have demonstrated a differential effect of aspirin in women in comparison with men, with a reduction of stroke versus myocardial infarctions, respectively. 4 …”

Section: The Effect Of Sex On Medicationsmentioning

confidence: 99%

“…Despite the wealth of evidence that sex is one of the strongest modulators of CVD risk, CVD pathophysiology, and impacts diagnostic testing and response to treatment, the consideration of sex in clinical decision making is rarely considered. 4 Given the evidence showing poorer management and outcomes for women with CVD, women's cardiovascular programs are essential to correct the persistent inequities of CVD care and prevention in women. The potential of these programs is also their ability to impact existing research gaps.…”

Section: The Need For Women's Cardiovascular Health Programsmentioning

confidence: 99%

Improving the Cardiovascular Health of Women in the Nation

Gulati

2017

Circulation

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Despite recent declines in cardiovascular mortality in women over the past decade, cardiovascular disease (CVD) remains the number 1 killer of women.1 Deaths attributable to CVD outnumber the deaths attributable to breast, ovarian, uterine, cervical, or vaginal cancers, or childbirth combined, and yet, when the medical community refers to women's health, they continue to focus on the bikini boundaries. SEX DIFFERENCES IN TREATMENT FOR CVDWomen continue to be labeled as a special population in many guidelines relating to CVD, despite being the majority of the population. Nonetheless, when presenting with an acute coronary syndrome, it is women, in particular, younger women, who are less likely to receive guideline-recommended therapies, timeliness of care, or diagnostic and invasive therapies resulting in worse outcomes in comparison with men.2 Women who experience cardiac arrest are less likely to receive bystander CPR than men, and less likely to receive guideline-recommended therapies. The prevalence of heart failure is greater in women than in men, and, despite the sex differences in the causes and types of heart failure, women with heart failure with reduced ejection fraction are less likely to receive evidence-based therapies, including medications, implantable cardioverter defibrillators, ventricular assist devices, and heart transplant, despite improved survival and quality of life when receiving these therapies. Asymptomatic peripheral artery disease is twice as common in women as in men, and once a diagnosis of peripheral artery disease is made, women have greater functional impairment, lower rates of revascularization, and an increased likelihood of emergent procedures. This persistent pattern of poorer cardiovascular outcomes appears predominantly attributable to suboptimal use of guideline-recommended therapy in women, despite the strong evidence that management of CVD with evidence-based therapies benefits both sexes equally. SEX-SPECIFIC CVD RISK FACTORSThere are unique CVD risk factors for women related to pregnancy or hormonal influences. The effect of adverse pregnancy outcomes is emerging as an important predictor of future CVD risk. Pregnancies associated with preterm delivery, gestational diabetes, gestational hypertension, preeclampsia, and eclampsia increase the risk of future CVD. Pregnancy appears to be a natural stress test identifying at-risk women, but because these conditions disappear postpartum, the increased CVD risk is often not translated to women. These adverse pregnancy outcomes are also not assessed when using current CVD risk assessment tools. Other unique risk factors for women include polycystic ovarian syndrome), functional hypothalamic amenorrhea, menopausal status and hormone use, also not assessed in contem-

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Consideration of Sex Differences in Medicine to Improve Health Care and Patient Outcomes

Cited by 142 publications

References 11 publications

Revolution of Alzheimer Precision Neurology. Passageway of Systems Biology and Neurophysiology

Revolution of Alzheimer Precision Neurology. Passageway of Systems Biology and Neurophysiology

A Comparison of Sex Differences in Psychotropic Medication Use in Older People with Alzheimer’s Disease in the US and Finland

Improving the Cardiovascular Health of Women in the Nation

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