SEX & GENDER
Effects of Sex and Gender on Obesity and Cardiovascular Disease
SAEM PULSE | JULY-AUGUST 2022
By Nina Faynshtayn, Ynhi Thomas, MD, MPH, MSc; and Connie Newman, MD, on behalf of the SAEM Sex and Gender in Emergency Medicine Interest Group
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Consideration of sex and gender is crucial for improving medical care. Historically, in terms of research and clinical practice, differences between men and women have seldom been considered and analyzed thoroughly. One example is cardiovascular health. Women and men present with varying symptoms of acute coronary syndrome, and women are less likely to be diagnosed and treated. Research has focused primarily on men’s bodies, yet there are significant sex differences that need to be studied, such as the effects of cardiovascular drugs and patterns of coronary artery plaque distribution. Obesity is a risk factor for cardiovascular disease and sex differences in obesity should be
“Beyond physiological differences, lifestyle differences based on sex and gender may influence obesity.” considered. Fat deposition differs between males and females. In males, fat is mainly located in the visceral area (which is associated with increased risk of cardiovascular disease), and in premenopausal females, fat deposits are largely subcutaneous. Fat may be dysfunctional in obesity and release substances called cytokines that have negative effects on the heart. Genetic,
epigenetic, and hormonal factors are responsible for sex differences in adipose tissue distribution. Estrogen plays a critical role in energy balance, acting on the brain to reduce food intake and increase physical activity and energy expenditure. Also, it is important to note that estrogen deficiency, which occurs during menopause, is associated with diabetes and obesity.
