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Invited Commentary
August 2014

The Case for Sex- and Gender-Specific Medicine

Author Affiliations
  • 1Barbra Streisand Women’s Heart Center, Cedars Sinai Heart Institute, Los Angeles, California
  • 2Institute for Gender in Medicine, Charite University Medicine, Berlin, Germany
  • 3German Cardiovascular Research Center (DZHK), Berlin, Germany
JAMA Intern Med. 2014;174(8):1348-1349. doi:10.1001/jamainternmed.2014.320

There are numerous differences in cardiovascular disease (CVD) between men and women. Women have a higher prevalence of coronary microvascular dysfunction, heart failure with preserved ejection fraction, Tako-Tsubo syndrome (also known as stress-induced cardiomyopathy), and post–myocardial infarction depression than men. Women also have a greater sensitivity to QT-prolonging medications and higher heart failure mortality with digoxin than men.1,2 A mounting literature further documents important sex differences in pharmacology, including response to β-blockers and angiotensin converting enzyme inhibitors.3

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    1 Comment for this article
    USPSTF ignored NIH mandate for sex-specific analysis of data
    David L. Keller, MD | Independent Physician
    I agree with the National Institutes of Health (NIH) mandate to include both men and women in clinical studies and, when the studied health condition affects both sexes, to analyze data by sex. The United States Preventative Services Task Force (USPSTF) recently updated their report on multivitamin supplements, and again found \"insufficient evidence\" to recommend their general use. The USPSTF report dismissed the significant reduction in cancers seen in men in both the SU.VI.MAX and Physicians' Health Study (PHS II), stating: \"The lack of effect in women and the use of different supplement formulations in the 2 trials make extrapolating these findings to the general population difficult.\"(1) This statement constitutes a clear violation of the NIH mandate to analyze the trial data separately by sex. Please read my \"Open Letter to the USPSTF\" (1) for a more complete analysis of the sex-specific data, and conclusive arguments for reclassifying the use of multivitamin and mineral supplements for men over age 50 to Category C, meaning they should discuss their diet and nutritional status with their doctors to determine whether they should add a nutritional supplement.1: Moyer VA; U.S. Preventive Services Task Force. Vitamin, mineral, andmultivitamin supplements for the primary prevention of cardiovascular disease andcancer: U.S. Preventive services Task Force recommendation statement. Ann Intern Med. 2014 Apr 15;160(8):558-64. doi: 10.7326/M14-0198. PubMed PMID: 24566474.2: Keller DL; Open Letter to the USPSTF: the evidence shows multivitamins reduce cancers in men. http://www.ncbi.nlm.nih.gov/pubmed/24566474#cm24566474_4093