Hernandez Leah, Laucyte-Cibulskiene Agne, Ward Liam J, Kautzky-Willer Alexandra, Herrero Maria-Trinidad, Norris Colleen M, Raparelli Valeria, Pilote Louise, Stenvinkel Peter, Kublickiene Karolina
Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Department of Nephrology, Lund University, Skåne University Hospital, Malmö, Sweden.
Front Cardiovasc Med. 2022 Aug 8;9:916194. doi: 10.3389/fcvm.2022.916194. eCollection 2022.
Cardio-pulmonary diseases, which were once regarded as a man's illness, have been one of the leading causes of morbidity and mortality for both men and women in many countries in recent years. Both gender and sex influence the functional and structural changes in the human body and therefore play an important role in disease clinical manifestation, treatment choice, and/or response to treatment and prognosis of health outcomes. The gender dimension integrates sex and gender analysis in health sciences and medical research, however, it is still relatively overlooked suggesting the need for empowerment in the medical research community. Latest advances in the field of cardiovascular research have provided supportive evidence that the application of biological variables of sex has led to the understanding that heart disease in females may have different pathophysiology compared to males, particularly in younger adults. It has also resulted in new diagnostic techniques and a better understanding of symptomatology, while gender analysis has informed more appropriate risk stratification and prevention strategies. The existing knowledge in the pulmonary field shows the higher prevalence of pulmonary disorders among females, however, the role of gender as a socio-cultural construct has yet to be explored for the implementation of targeted interventions. The purpose of this review is to introduce the concept of gender dimension and its importance for the cardiopulmonary continuum with a focus on shared pathophysiology and disease presentation in addition to interrelation with chronic kidney disease. The review presents basic knowledge of what gender dimension means, and the application of sex and gender aspects in cardiovascular medicine with a specific focus on early pulmonary development, pulmonary hypertension, and chronic obstructive pulmonary disease (COPD). Early vascular aging and inflammation have been presented as a potential pathophysiological link, with further interactions between the cardiopulmonary continuum and chronic kidney disease. Finally, implications for potential future research have been provided to increase the impact of gender dimension on research excellence that would add value to everybody, foster toward precision medicine and ultimately improve human health.
心肺疾病曾被视为男性疾病，近年来在许多国家已成为男性和女性发病和死亡的主要原因之一。性别和性都会影响人体的功能和结构变化，因此在疾病临床表现、治疗选择和/或对治疗的反应以及健康结果的预后方面发挥着重要作用。性别维度将性和性别分析整合到健康科学和医学研究中，然而，它仍然相对被忽视，这表明医学研究界需要增强这方面的意识。心血管研究领域的最新进展提供了支持性证据，即性生物学变量的应用使人们认识到，与男性相比，女性心脏病可能具有不同的病理生理学，尤其是在年轻成年人中。这也带来了新的诊断技术，并增进了对症状学的理解，而性别分析为更合适的风险分层和预防策略提供了依据。肺部领域的现有知识表明，肺部疾病在女性中的患病率较高，然而，作为一种社会文化结构的性别的作用尚未在实施针对性干预措施方面得到探索。本综述的目的是介绍性别维度的概念及其对心肺连续体的重要性，重点关注共同的病理生理学和疾病表现，以及与慢性肾脏病的相互关系。该综述介绍了性别维度的基本含义，以及性和性别因素在心血管医学中的应用，特别关注早期肺发育、肺动脉高压和慢性阻塞性肺疾病（COPD）。早期血管老化和炎症已被视为一种潜在的病理生理联系，心肺连续体与慢性肾脏病之间存在进一步的相互作用。最后，提供了对未来潜在研究的启示，以增加性别维度对卓越研究的影响，这将为每个人增添价值，促进精准医学发展，并最终改善人类健康。
