Sex affects health: women are different than men Body composition & metabolism Cardiovascular Disease Chronic Conditions I.  II.  III.  Osteoporosis Autoimmune conditions Alzheimer’s Disease A.  B.  C.  Sex affects health Overview: n  Males & females have different patterns of illness & health q  Longevity Gap: 5.1 years (2007); highly dependent upon income: http://www.nytimes.com/2014/03/16/business/income-gap-meet-the-longevity-gap.html? partner=rss&emc=rss&_r=1 q  q  q  q  q  q  n  Cancer kills men at a higher rate than it kills women Women are 3x more likely than men to suffer from depression in part because women’s brains make less of the hormone serotonin Smoking has a more negative effect on cardiovascular health in women than men. Women are 2x more likely than men to contract a sexually transmitted disease Women tend to wake up from anesthesia more quickly than men Some pain medications (known as kappa-opiates) are far more effective in relieving pain in women than in men Diseases other than those of the reproductive system affect both sexes, often with different frequencies or presentations – or they may require different treatments I. Body composition & metabolism n  Body fat – mammary fat & glutealfemoral fat are preserved in females under conditions of starvation and are preferentially mobilized during lactation q  q  Women have 34% less lean body mass (testosterone increases muscle growth) Females more likely to maintain body fat than males (mean = 22% as compared to 14% for males) n  þ  þ  þ  Males tend to have relatively more abdominal fat and less gluteal-femoral fat Hormonal changes may increase a female’s appetite Menopause is associated with a shift toward more fat + deposition of fat in abdominal region Differences due to??? 1 II. Cardiovascular Disease (CVD) Group of disorders of the heart and blood vessels, they include: •  •  •  •  •  •  Coronary heart disease Cerebrovascular disease Peripheral arterial disease Rheumatic heart disease Congenital heart disease Deep vein thrombosis and pulmonary embolism Atherosclerosis Normal Myocardial Infarction = Heart Attack Symptoms: Risk Factors for CAD n  n  n  n  n  n  n  Family history Hypercholesterolemia - high blood cholesterol and triglycerides Hypertension Cigarette smoking Impaired fasting glucose - pre-diabetes Obesity Physical inactivity 2 Women & Cardiovascular Disease n  Heart disease is the #1 killer of women q  q  q  q  n  Prevalence - 2012 q  n  n  Since 1984, the number of CVD deaths for females has exceeded those for males. Nearly twice as many women in the United States die of heart disease, stroke and other cardiovascular diseases as from all forms of cancer, including breast cancer. Responsible for ¼ (CDC) to 1/3 (American Heart Association) of all female deaths Most women don’t think it’s a problem though! 42 million women in the US Over two-thirds (64%) of women who die suddenly of coronary heart disease have no previous symptoms The death rate due to CVD is substantially higher in African American women than in Caucasian women q  Death rate from CVD per 100,000 individuals (Health US, 2009): n  n  Caucasian women = 160.9 African American women = 212.5 Globally, >80% of deaths from CVDs occur in low and middle-income countries (WHO) Prevalence of Cardiovascular Diseases in Americans Age 20 and Older by Age and Sex (American Heart Association, 2012) 3 38% of women compared to 25% of men will die within 1 year after a heart attack. 40 35 30 25 20 15 10 5 0 Gender? § Women are slower to recognize the presence of heart attacks in because “characteristic” patterns of chest pain and changes on electrocardiograms are less frequently present § Physicians are less likely to order tests to evaluate chest pain in women than in men § Women are two to three times as likely to die following heart bypass surgery http://www.womensheart.org/content/Outreach/PurpleRibbonCampaign/whatis_purpleribboncampaign.asp Heart attacks present themselves differently in men than women! Ø  The majority of women (78%) reported at least one symptom for more than one month before their heart a:ack ü  unusual fa>gue ü  sleep disturbances ü  shortness of breath ü  indiges>on ü  anxiety Ø  Only 30% reported chest discomfort, which was described as an aching, >ghtness, pressure, sharpness, burning, fullness or >ngling. If you think you, or someone else, may be having a heart attack, wait no more than a few minutes — five at most — before calling 911. 4 III. Chronic Conditions n  n  Chronic diseases, in contrast to acute diseases, are condi>ons that generally last longer than several weeks. Some chronic diseases have a greater prevalence in women A.  Osteoporosis B.  Autoimmune disease C.  Alzheimer’s Honeycomb structure weakened A. Osteoporosis Osteoporosis – disorder of low bone mass, microarchitectural denegration and bone weakness that leads to fracture Results when the rate of bone resorption outstrips the rate of bone formation •  •  Ø  Hip fracture – most common Women lose bone density at the same pace until menopause, then they lose 2-3% per year for approximately 10 years Normal bone: T-score better than -1. Osteopenia: T-score between -1 and -2.5 Osteoporosis: T-score less than -2.5 The T-score compares your bone mineral density (BMD) to the expected bone density value of a healthy young adult (about age 30) of the same sex and ethnicity. 5 Factors that contribute to bone health (+) Estrogen & testosterone critical for maintenance of peak bone mass ü  Women at higher risk if they: experience irregular or infrequent periods, have had ovaries removed ü  (+) Dietary Calcium & Vitamin D required for bone formation ü  Premenopausal women should obtain Ca 1,000 mg/day Postmenopausal women – Ca 1,200 mg/day Vitamin D 600-800 IU/day ü  ü  ü  ü  ü  (+) Weight bearing exercise creates strong bone structure (-) Smoking weakens the bone structure (-) Certain drugs ( e.g. Corticosteroids) promote bone loss B. Autoimmune conditions n  The adap>ve immune response response is more vigorous in females than in males ü  ü  n  May be localized or ubiquitous q  q  n  n  plasma ac>vity level of phospholipase A2, a key enzyme in causing chronic inﬂammatory diseases, is signiﬁcantly higher in Caucasian women than their male counterparts Interleukin-‐1-‐receptor-‐II (reduces the inﬂammatory response), is present in higher concentra>on in men than women Diﬃcult to iden>fy leading causes, diﬃcult to diagnose May be associated with infec>ous agents (virus, bacteria) Many autoimmune disease are highly predominant in females, most during their child-‐bearing years Systemic and organ-‐speciﬁc autoimmune diseases, (e.g. rheumatoid arthri>s, myocardi>s) are the leading cause of death in women >65 years of age Unlike antibodies directed against invading infectious pathogens, autoantibodies are directed against the body's own cells and can disturb their function. 6 circumstantial evidence links autoimmune diseases with preceding infections Infections occur before the onset of symptoms of autoimmune disease, making links to specific causative agents difficult. When a person is first infected (day 0), usually no symptoms are apparent. Signs and symptoms of autoimmune disease are clearly present and easily confirmed by physicians during the chronic stage of autoimmunity. However, the infection has been cleared by this time, making it difficult to establish that an infection caused the autoimmune disease (from Fairweather & Rose, 2004) Some common autoimmune diseases: n  Hashimoto’s thyroidi>s (underac>ve thyroid) (10:1 fem to male) q  q  q  q  n  Graves’ disease (overac>ve thyroid) (7:1) q  q  n  q  swelling and damage to the joints, skin, kidneys, heart, lungs, blood vessels, and brain rashes on parts of the body Mul>ple sclerosis (MS) (2:1) q  q  q  n  Insomnia, irritability, weight loss, heat sensi>vity, ﬁne bri:le hair weakness in your muscles, shaky hands Lupus (9:1) q  n  Tiredness, depression sensi>vity to cold, muscle weakness and cramps weight gain, dry hair, tough skin cons>pa>on weakness and trouble with coordina>on, balance, speaking, and walking tremors numbness and >ngling feeling in arms, legs, hands, and feet Rheumatoid arthri>s (2.5:1) q  q  inﬂamma>on of the joints muscle pain, weakness, fa>gue Ø Symptoms of autoimmune diseases can come and go, and severity can vary Autoimmune diseases affect approximately 8% of the population, 78% of whom are women (CDC) millions women affected by autoimmune disease 7 Why are these autoimmune diseases affecting more females than males? 1)  Genetics? 2)  Hormones? - Hormonal interactions w/immune system not yet understood q  q  3)  Proinflammatory cytokines stimulate the release of glucocorticoids from the hypothalamus-pituitary-adrenal axis, which regulates the inflammatory process, along with androgens and estrogen Recent study found that Estrogen amplifies the immune response to coxsackievirus B3 in mice, increasing TNF-α and IL-4 levels Different environmental exposure C. Alzheimer’s Disease n  Women in their 60s twice as likely to develop Alzheimer's disease over the rest of their lives as they are breast cancer Alzheimer's Association 2014 Alzheimer's Disease Facts and Figures report released today, a woman's estimated lifetime risk of developing Alzheimer's at age 65 is 1 in 6, compared with nearly 1 in 11 for a man. AND…there are 2.5 times as many women than men providing intensive "on- duty" care 24 hours for someone living with Alzheimer's disease Symptoms: problems with memory, judgment, and thinking; Memory loss and dementia will progress as the stages of Alzheimer's advance. Recent study: ApoE4 mutation 8