A simple difference in the genetic code—two X chromosomes versus one X chromosome and one Y chromosome—can lead to major differences in heart disease. It appears that these genetic differences influence more than just sex organs and sex assigned at birth—they fundamentally alter how cardiovascular disease develops and presents.

While gender influences the mechanisms behind the development of cardiovascular disease, gender plays a role in how healthcare providers recognize and manage it. Sex refers to biological characteristics such as genetics, hormones, anatomy and physiology, whereas gender refers to social, psychological and cultural constructions. Women are more likely to die after a first heart attack or stroke than men. Women are also more likely to have it additional or different heart attack symptoms that go beyond chest pain, such as nausea, jaw pain, dizziness and fatigue. It is often difficult to fully disentangle the influences of gender on cardiovascular disease outcomes from the influences of gender.

While women who have not entered menopause have a lower risk of cardiovascular disease than men, their cardiovascular risk it accelerates dramatically after menopause. In addition, if a woman has type 2 diabetes, her risk of heart attack accelerates equivalent to that of meneven if the woman with diabetes has not yet gone through menopause. Additional data are needed to better understand the differences in cardiovascular disease risk non-binary and transgender patients.

Despite these differences, one key thing is the same: heart attack, stroke, and other forms of cardiovascular disease are the main cause of death for all people, regardless of sex or gender.

We are researchers who studies women’s health and how cardiovascular disease it develops and presents differently in women and men. Our work identified a crucial need to update medical guidelines with more sex-specific approaches to diagnosis and treatment to improving health outcomes for all.

Gender differences in heart disease

The reasons behind it sex and gender differences in cardiovascular diseases are not completely known. Nor are the distinct biological effects of sex, such as hormonal and genetic factors, versus gender, such as social, cultural, and psychological factors, clearly differentiated.

What researchers do know is that evidence is accumulating about what good heart care should look like for women compared to men it has as many holes as swiss cheese. Medical evidence for treating cardiovascular disease often comes from studies that excluded women because women, for the most part, were not included in scientific research until NIH Revitalization Act of 1993. For example, current guidelines for treating cardiovascular risk factors such as high blood pressure are based primarily on data from men. This is despite evidence that differences in how cardiovascular disease develops cause women to experience cardiovascular disease differently.

In addition to gender differences, of course gender bias among providers and social gender norms among patients lead doctors to underestimate the risk of cardiac events in women compared to men. These biases play a role in why women are more likely than men to die from cardiac events. For example, for patients with symptoms that are borderline for cardiovascular disease, clinicians tend to be more aggressive in ordering arterial imaging for men than for women. One study linked this tendency to order less aggressive tests for women in part to a gender bias that men are more open than women to taking risks.

In a study of about 3,000 patients with a recent heart attack, women were less likely than men to believe that heart attack symptoms were due to a heart condition. In addition, most women do not know that cardiovascular disease is the leading cause of death among women. In general, women’s misperceptions of their own risk may prevent them from going to a doctor to check for possible symptoms of a heart attack or stroke.

These issues are even more pronounced for women of color. Lack of access to health care and additional challenges generates health disparities among underrepresented racial and ethnic minority populations.

Sex difference in heart disease

Cardiovascular disease looks physically different for women and men, particularly in the buildup of plaque on the artery walls that contributes to the disease.

Women have fewer cholesterol crystals and less calcium deposits in their arterial plaque than men do. Physiological differences in the smallest blood vessels heart nutrition also plays a role in cardiovascular outcomes.

Women are more likely than men to have cardiovascular disease that presents as multiple narrowed arteries that are not completely “clogged” leading to chest pain because blood flow cannot increase enough to meet the higher oxygen demands during exercise , just like a flow shower head. When chest pain presents itself in this way, doctors call this condition ischemia and no obstructive coronary arteries. In comparison, men are more likely to have an artery “clogged” in a concentrated area that can be opened with a stent or heart bypass surgery. Options for multiple narrowed arteries have lagged behind treatment options for typical “clogged” arteries, putting women at a disadvantage.

In addition, in the early stages of a heart attack, the levels of blood markers that indicate damage to the heart are smaller in women than in men. This may lead to more missed diagnoses of coronary heart disease in women compared to men.

The reasons for these differences are not entirely clear. Some potential factors include differences in the composition of arterial plaque that cause men’s plaque to tear or rupture and women’s plaque to erode more. Women have too smaller heart mass and smaller arteries than men even after accounting for body size.

Reducing gender disparities

Too often, women with symptoms of cardiovascular disease are turned away from doctor’s offices because of the gender bias that “women don’t get heart disease.”

Considering how symptoms of cardiovascular disease vary by sex and gender could help doctors better care for all patients.

One way the rubber meets is on better approaches to diagnosing heart attacks for women and men. Specifically, when heart attacks are diagnosed, gender-specific cutoffs are used for blood tests that measure heart damage – called high-sensitivity troponin tests — maybe improving their accuracydecreasing missed or false negative diagnoses in women, while also decreasing overdiagnosis or false positives in men.

Our research lab leaders, CONTRIBUTORS and other internationally recognized research colleagues – some of whom are partners with us Ludeman Family Center for Women’s Health Research on the University of Colorado Anschutz Medical Campus — will continue this important work to close this gender gap in health care. Research in this field is essential to shed light on how clinicians can better address sex-specific symptoms and deliver more personalized treatments.

The The Biden administration’s recent executive order to advance women’s health research paves the way for research to go beyond simply understanding what causes gender differences in cardiovascular disease. Developing and testing appropriate approaches to care for each patient can help achieve better health for all.

This article was originally published on conversation by Amy Huebschmann and Judith Regensteiner at the University of Colorado Anschutz Medical Campus. Read on original article here.