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Experts say any diseases affect women and men differently. Sean Locke/Stocksy United
  • Researchers are suggesting that different guidelines for men and women be drawn up for the treatment of obesity, high blood pressure, and diabetes.
  • They say these conditions as well as cardiovascular disease affect women differently than they do men.
  • Experts say women have historically been underrepresented in clinical trials, leading to treatment guidelines that are more applicable to men.

A new study suggests there should be two sets of guidelines for treating adults with obesity, high blood pressure, and diabetes – one for men and one for women.

Until the 1990s, clinical trials used mainly male participants. Scientists thought that diseases behaved the same no matter the gender. Women were often excluded from clinical trials unless it was for women’s reproductive health.

Because of this, there was one set of guidelines for preventing, diagnosing, and treating many diseases, including obesity, high blood pressure, and diabetes.

Some experts say current guidelines aren’t as helpful for women because they were designed based on how these conditions manifest and affect men.

Some of the differences in how the diseases differ based on gender include:

  • High blood pressure can lead to cardiovascular disease, the leading cause of mortality in women. Hypertension is higher in men before age 60, but after women reach menopause, the rate increases.
  • Obesity rates are similar for men and women. However, the biology of the disease can cause an increased cardiometabolic risk in women.
  • Women who had gestational diabetes are at a higher risk of cardiovascular disease.

The risk factors, time of onset, and the manifestation of these conditions are different in men and women. Given that, the study researchers point out that there must be equality in clinical studies, which might lead to guidelines for treating the diseases differently by gender.

Dr. Dimitar Marinov, an assistant professor in hygiene and epidemiology at the Medical University of Varna in Bulgaria, agrees that guidelines should be gender-specific, especially for obesity.

“Women may suffer from hidden forms of obesity. This happens when they have very low muscle mass and high body fat mass,” he told Healthline. “Due to the low muscle mass, their body frame, body weight, and BMI appear normal. Diagnosing hidden forms of obesity can help with the prevention of heart disease and type 2 diabetes.”

But not everyone agrees.

Dr. Danine Fruge, the medical director at Pritikin Longevity Center in Miami, Florida, isn’t certain gender-based guidelines are needed. She does see the need for more research.

“I have seen no conclusive evidence for separate guidelines for men and women to diagnose and treat these conditions,” she told Healthline. “However, suppose significant differences in the pathophysiology of these diseases are discovered in men and women. In that case, separate guidelines for diagnosis and treatment could be beneficial.”

“Gender differences in hormones, body fat, and culture may play a role, but more research is needed,” she added. “However, many effective evidence-based lifestyle solutions exist, such as nutrition, exercise, restorative sleep, and a healthy mindset. I have seen these methods work firsthand at the Pritikin Longevity Center. They significantly improved and sometimes reversed obesity, hypertension, and even type two diabetes in men and women.”

Hypertension, obesity, and diabetes significantly increase the risk of cardiovascular disease.

Because of the lack of inclusion of women in clinical studies before the 1990s, researchers and medical professionals don’t know if treatments typically used for men are effective for women.

Despite this, it can still be difficult to recruit women for clinical studies, Judy Regensteiner, Ph.D., a professor of medicine at the University of Colorado Anschutz Medical Campus and the lead author of the new study, said in an interview.

“Often women take care of their kids or they are otherwise occupied. But you can recruit women, and women are very interested in participating. We just have to work harder at it,” she said.

Today, scientists try to include women in their studies, but they aren’t always successful.

“A recent huge blood pressure trial called the Systolic Blood Pressure Intervention Trial was supposed to establish whether sex-specific guidelines are needed. Still, not enough women joined the study, so the results were inconclusive,” Regensteiner noted.

Cardiovascular disease is one of many diseases where symptoms vary significantly between men and women.

“Women of reproductive age usually have a lower risk of heart disease due to the protective role of estrogen,” said Marinov. “However, once menopause occurs, the risk of heart disease skyrockets.”

Many of the risk factors for cardiovascular disease are similar in men and women. These include obesity, smoking, diabetes, and high blood pressure.

However, there are differences. Risk factors more common in women include:

  • High testosterone levels before menopause
  • Increasing hypertension during menopause
  • Autoimmune disorders
  • Stress, anxiety, and depression

There are also biological differences.

Men often have blockages of the major heart arteries and women have the disease in the small heart arteries, making women’s treatment more challenging.

There is also less awareness and recognition of symptoms in women. For example, chest pain is a common heart attack symptom in men, but women don’t necessarily have chest pain.

“If a woman goes to a heart doctor and says, ‘I ‘m having chest pain,’ she is still more likely to be told it is because of psychiatric causes,” said Regensteiner. “Women are still more likely to get turned away, saying, ‘Ah, don’t worry about it, you’re a woman. Women don’t get heart disease.'”

Females are also more likely to experience indigestion, nausea, dizziness, or shortness of breath – or they might not have any symptoms.

Doctors and other medical professionals can easily miss or misdiagnose heart attacks in women.

A study completed in 2020 found that aspirin, statins, and antihypertensive medication prescriptions, including beta or calcium channel blockers, are not prescribed for women as often as for men.

One of the commonly used diagnostic tools for cardiovascular disease is cardiac catheterization. However, this looks for blockages in the large arteries, which is less common in women who usually show disease in the smaller arteries. Women might need a cardiac MRI to look for inflammation.