Sex and Gender Differences in Medical Education: The Impact on
Scientific Reports

Anna Vittoria      Mattioli; Francesca      Coppi; Valentina      Bucciarelli; Milena      Nasi; Marcello      Pinti; Carla      Palumbo; Sabina      Gallina
Abstract

This commentary explores the reasons why sex and gender differences must be included in medical education and the impact on healthcare outcomes for patients. Understanding sex and gender differences could be useful in making more accurate diagnoses and to develop more effective treatment plans. Sex and gender medicine take into consideration both the genetic basis and the effects of exposure to environmental and socio-economic factors.
Keywords: Sex, gender, teaching, women, non-communicable disease, risk factors, socio-economic factors.
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[1]
Göttgens I, Oertelt-Prigione S. Moving beyond gender identity: The need for contextualization in gender-sensitive medical research. Lancet Reg Health Eur  2023; 24: 100548.
 [http://dx.doi.org/10.1016/j.lanepe.2022.100548] [PMID: 36643661]

[2]
Mattioli AV, Nasi M, Pinti M, Palumbo C. Teaching gender differences at medical school could improve the safety and efficacy of personalized physical activity prescription. Front Cardiovasc Med  2022; 9: 919257.
 [http://dx.doi.org/10.3389/fcvm.2022.919257] [PMID: 35811713]

[3]
Franconi F, Campesi I, Colombo D, Antonini P. Sex-gender variable: Methodological recommendations for increasing scientific value of clinical studies. Cells  2019; 8(5): 476.
 [http://dx.doi.org/10.3390/cells8050476] [PMID: 31109006]

[4]
Regensteiner JG, Reusch JEB. Sex differences in cardiovascular consequences of hypertension, obesity, and diabetes. J Am Coll Cardiol  2022; 79(15): 1492-505.
 [http://dx.doi.org/10.1016/j.jacc.2022.02.010] [PMID: 35422246]

[5]
Gentilin A, Moghetti P, Cevese A, Mattioli AV, Schena F, Tarperi C. Circadian and sex differences in carotid-femoral pulse wave velocity in young individuals and elderly with and without type 2 diabetes. Front Cardiovasc Med  2022; 9: 952621.
 [http://dx.doi.org/10.3389/fcvm.2022.952621] [PMID: 36158808]

[6]
Woodward M. Cardiovascular disease and the female disadvantage. Int J Environ Res Public Health  2019; 16(7): 1165.
 [http://dx.doi.org/10.3390/ijerph16071165] [PMID: 30939754]

[7]
Gogovor A, Zomahoun HTV, Ekanmian G, et al. Sex and gender considerations in reporting guidelines for health research: A systematic review. Biol Sex Differ  2021; 12(1): 62.
 [http://dx.doi.org/10.1186/s13293-021-00404-0] [PMID: 34801060]

[8]
Lunova T, Komorovsky R, Klishch I. Gender differences in treatment delays, management and mortality among patients with acute coronary syndrome: A systematic review and meta-analysis. Curr Cardiol Rev  2023; 19(1): e300622206530.
 [http://dx.doi.org/10.2174/1573403X18666220630120259] [PMID: 35786190]

[9]
Kusnoor AV, Ferguson AD, Falik R. Ischemic heart disease in women: A review for primary care physicians. South Med J  2011; 104(3): 200-4.
 [http://dx.doi.org/10.1097/SMJ.0b013e31820bffd3] [PMID: 21297529]

[10]
Mattioli AV, Moscucci F, Sciomer S, et al. Cardiovascular prevention in women: An update by the Italian Society of Cardiology working group on ‘Prevention, hypertension and peripheral disease’. J Cardiovasc Med  2023; 24 (Suppl. 2): e147-55.
 [http://dx.doi.org/10.2459/JCM.0000000000001423] [PMID: 37186565]

[11]
Deraz O, Caceres B, Streed CG Jr, et al. Sexual minority status disparities in life’s essential 8 and life’s simple 7 cardiovascular health scores: A french nationwide population-based study. J Am Heart Assoc  2023; 12(11): e028429.
 [http://dx.doi.org/10.1161/JAHA.122.028429] [PMID: 37195318]

[12]
Santos JD, Oliveira-Neto JT, Tostes RC. The cardiovascular subtleties of testosterone on gender-affirming hormone therapy. Am J Physiol Heart Circ Physiol  2023; 325(1): H30-53.
 [http://dx.doi.org/10.1152/ajpheart.00015.2023] [PMID: 37145958]

[13]
Rebić N, Law MR, Cragg J, et al. What's sex and gender got to do with it?" A scoping review of sex and genderbased analysis in pharmacoepidemiologic studies of medication adherence. Value Health  2023; S1098-3015(23): 02559-7.
 [http://dx.doi.org/10.1016/j.jval.2023.04.002]

[14]
Masumori N, Nakatsuka M. Cardiovascular risk in transgender people with gender-affirming hormone treatment. Circ Rep  2023; 5(4): 105-13.
 [http://dx.doi.org/10.1253/circrep.CR-23-0021] [PMID: 37025940]

[15]
Sabin J, Guenther G, Ornelas IJ, et al. Brief online implicit bias education increases bias awareness among clinical teaching faculty. Med Educ Online  2022; 27(1): 2025307.
 [http://dx.doi.org/10.1080/10872981.2021.2025307] [PMID: 35037585]

[16]
Cocchi C, Coppi F, Farinetti A, Mattioli AV. Cardiovascular disease prevention and therapy in women with Type 2 diabetes. Future Cardiol  2021; 17(3): 487-96.
 [http://dx.doi.org/10.2217/fca-2021-0011] [PMID: 33739145]

[17]
Hui K, Sukhera J, Vigod S, Taylor VH, Zaheer J. Recognizing and addressing implicit gender bias in medicine. CMAJ  2020; 192(42): E1269-70.
 [http://dx.doi.org/10.1503/cmaj.200286] [PMID: 33077523]

[18]
Harper LJ, Kidambi P, Kirincich JM, Thornton JD, Khatri S, Culver DA. Health disparities: Interventions for pulmonary disease : A narrative review. Chest  2023; S0012-3692(23): 00302-1.
 [http://dx.doi.org/10.1016/j.chest.2023.02.033]

[19]
Humphries KH, Izadnegahdar M, Sedlak T, et al. Sex differences in cardiovascular disease - Impact on care and outcomes. Front Neuroendocrinol  2017; 46: 46-70.
 [http://dx.doi.org/10.1016/j.yfrne.2017.04.001] [PMID: 28428055]

[20]
Ruder K. Large study finds women are (Still) much more likely to die or have complications after coronary artery bypass graft surgery than men. JAMA  2023; 329(11): 872-3.
 [http://dx.doi.org/10.1001/jama.2023.1806] [PMID: 36857088]

[21]
Gender Studies in Product Development. Historical Overview:.  2018. Available from:  https://www.fda.gov/science-research/womens-health-research/gender-studies-product-development-historical-overview

[22]
Bierer BE, Meloney LG, Ahmed HR, White SA. Advancing the inclusion of underrepresented women in clinical research. Cell Rep Med  2022; 3(4): 100553.
 [http://dx.doi.org/10.1016/j.xcrm.2022.100553] [PMID: 35492242]

[23]
Bierer BE, Meloney LG. Strategies to optimize inclusion of women in multi-national clinical trials. Contemp Clin Trials  2022; 117: 106770.
 [http://dx.doi.org/10.1016/j.cct.2022.106770] [PMID: 35500726]

[24]
Mattioli AV, Selleri V, Zanini G, et al. Physical activity and diet in older women: A narrative review. J Clin Med  2022; 12(1): 81.
 [http://dx.doi.org/10.3390/jcm12010081] [PMID: 36614882]

[25]
Franconi F, Brunelleschi S, Steardo L, Cuomo V. Gender differences in drug responses. Pharmacol Res  2007; 55(2): 81-95.
 [http://dx.doi.org/10.1016/j.phrs.2006.11.001] [PMID: 17129734]

[26]
Tran C, Knowles SR, Liu BA, Shear NH. Gender differences in adverse drug reactions. J Clin Pharmacol  1998; 38(11): 1003-9.
 [http://dx.doi.org/10.1177/009127009803801103] [PMID: 9824780]

[27]
Paolisso P, Bergamaschi L, Saturi G, D’Angelo EC, Magnani I. Seconary prevention medical therapy and outcomes in patients with myocardial infarction with non-obstructive coronary artery disdease. Front Pharmacol  2020; 10: 1606.
 [http://dx.doi.org/10.3389/fphar.2019.01606] [PMID: 32082147]

[28]
Montemitro C, Cavallotto C, Giovannetti G, et al. Analysis of female enrollment in clinical trials for alcohol and substance use disorders: Is it time for sex-informed pharmacotherapy? Contemp Clin Trials  2022; 118: 106784.
 [http://dx.doi.org/10.1016/j.cct.2022.106784] [PMID: 35618230]

[29]
Olubodun JO, Ochs HR, Von Moltke LL, et al. Pharmacokinetic properties of zolpidem in elderly and young adults: Possible modulation by testosterone in men. Br J Clin Pharmacol  2003; 56(3): 297-304.
 [http://dx.doi.org/10.1046/j.0306-5251.2003.01852.x] [PMID: 12919178]

[30]
Os I, Bratland B, Dahlöf B, Gisholt K, Syvertsen JO, Tretli S. Female preponderance for lisinopril-induced cough in hypertension. Am J Hypertens  1994; 7(11): 1012-5.
 [http://dx.doi.org/10.1093/ajh/7.11.1012] [PMID: 7848615]

[31]
Shan Y, Cheung L, Zhou Y, Huang Y, Huang RS. A systematic review on sex differences in adverse drug reactions related to psychotropic, cardiovascular, and analgesic medications. Front Pharmacol  2023; 14: 1096366.
 [http://dx.doi.org/10.3389/fphar.2023.1096366] [PMID: 37201021]

[32]
Essebag V, Reynolds MR, Hadjis T, et al. Sex differences in the relationship between amiodarone use and the need for permanent pacing in patients with atrial fibrillation. Arch Intern Med  2007; 167(15): 1648-53.
 [http://dx.doi.org/10.1001/archinte.167.15.1648] [PMID: 17698688]

[33]
Roten L, Rimoldi SF, Schwick N, Sakata T, Heimgartner C, Fuhrer J, et al. Gender differences in patients referred for atrial fibrillation management to a tertiary center. Pacing Clin Electrophysiol  2009; 32(5): 622.
 [http://dx.doi.org/10.1111/j.1540-8159.2009.02335.x]

[34]
van Erven L, Schalij MJ. Amiodarone: An effective antiarrhythmic drug with unusual side effects. Heart  2010; 96(19): 1593-600.
 [http://dx.doi.org/10.1136/hrt.2008.152652] [PMID: 20837671]

[35]
D’Ascenzi F, Sciaccaluga C, Cameli M, et al. When should cardiovascular prevention begin? The importance of antenatal, perinatal and primordial prevention. Eur J Prev Cardiol  2019; 28(4): 361-9.
 [http://dx.doi.org/10.1177/2047487319893832] [PMID: 33611390]

[36]
Khan SS, Brewer LC, Canobbio MM, et al. Optimizing prepregnancy cardiovascular health to improve outcomes in pregnant and postpartum individuals and offspring: A scientific statement from the American Heart Association. Circulation  2023; 147(7): e76-91.
 [http://dx.doi.org/10.1161/CIR.0000000000001124] [PMID: 36780391]

[37]
Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation  2010; 121(4): 586-613.
 [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192703] [PMID: 20089546]

[38]
Vogel B, Acevedo M, Appelman Y, et al. The Lancet women and cardiovascular disease Commission: Reducing the global burden by 2030. Lancet  2021; 397(10292): 2385-438.
 [http://dx.doi.org/10.1016/S0140-6736(21)00684-X] [PMID: 34010613]

[39]
Johnathan T, Adrianne M, Katherine A, et al. Mietlicki-Baase, Macronutrient intake: Hormonal controls, pathological states, and methodological considerations. Appetite  2023; 180: 106365.

[40]
Vlassoff C. Gender differences in determinants and consequences of health and illness. J Health Popul Nutr  2007; 25(1): 47-61.
 [PMID: 17615903]

[41]
Coppi F, Nasi M, Farinetti A, Manenti A, Gallina S, Mattioli AV. Physical Activity, Sedentary Behaviour, and Diet in Menopausal Women: Comparison Between COVID19 “first wave” and “second wave” of Pandemic in Italy. Prog Nutr  2021; 23: e2021194.

[42]
McKenzie BL, Santos JA, Geldsetzer P, et al. Evaluation of sex differences in dietary behaviours and their relationship with cardiovascular risk factors: A cross-sectional study of nationally representative surveys in seven low- and middle-income countries. Nutr J  2020; 19(1): 3.
 [http://dx.doi.org/10.1186/s12937-019-0517-4] [PMID: 31928531]

[43]
Kittithaworn A, Toro-Tobon D, Sfeir JG. Cardiovascular benefits and risks associated with calcium, vitamin D, and antiresorptive therapy in the management of skeletal fragility. Womens Health  2023; 19: 17455057231170059.
 [http://dx.doi.org/10.1177/17455057231170059] [PMID: 37129172]

[44]
Sandberg AS, Scheers N. Phytic acid: Properties, uses, and determination.  In: Benjamin C, Paul MF, Fidel T, Eds. Encyclopedia of Food and Health.  Academic Press 2016; pp. 365-8.
 [http://dx.doi.org/10.1016/B978-0-12-384947-2.00544-4]

[45]
Di Natale C, Lucidi L, Montemitro C, et al. Gender differences in the psychopathology of obesity: How relevant is the role of binge eating behaviors? Brain Sci  2022; 12(7): 955.
 [http://dx.doi.org/10.3390/brainsci12070955] [PMID: 35884761]

[46]
Rocha-Rodrigues S, Sousa M, Lourenço Reis P, et al. Bidirectional interactions between the menstrual cycle, exercise training, and macronutrient intake in women: A review. Nutrients  2021; 13(2): 438.
 [http://dx.doi.org/10.3390/nu13020438] [PMID: 33572821]

[47]
Bardhan P, Yang T. Sexual dimorphic interplays between gut microbiota and antihypertensive drugs. Curr Hypertens Rep  2023; 25(8): 163-72.
 [http://dx.doi.org/10.1007/s11906-023-01244-6] [PMID: 37199902]

[48]
Valeri F, Endres K. How biological sex of the host shapes its gut microbiota. Front Neuroendocrinol  2021; 61: 100912.
 [http://dx.doi.org/10.1016/j.yfrne.2021.100912] [PMID: 33713673]

[49]
Miller V, Yusuf S, Chow CK, et al. Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels: Findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet Glob Health  2016; 4(10): e695-703.
 [http://dx.doi.org/10.1016/S2214-109X(16)30186-3] [PMID: 27567348]

[50]
Mattioli AV, Francesca C, Mario M, Alberto F. Fruit and vegetables in hypertensive women with asymptomatic peripheral arterial disease. Clin Nutr ESPEN  2018; 27: 110-2.
 [http://dx.doi.org/10.1016/j.clnesp.2018.05.010] [PMID: 30144882]

[51]
Bucciarelli V, Nasi M, Bianco F, et al. Depression pandemic and cardiovascular risk in the COVID-19 era and long COVID syndrome: Gender makes a difference. Trends Cardiovasc Med  2022; 32(1): 12-7.
 [http://dx.doi.org/10.1016/j.tcm.2021.09.009] [PMID: 34619336]

[52]
The Lancet Public Health. Time to tackle the physical activity gender gap. Lancet Public Health  2019; 4(8): e360.
 [http://dx.doi.org/10.1016/S2468-2667(19)30135-5] [PMID: 31345750]

[53]
Ricci F, Izzicupo P, Moscucci F, et al. Recommendations for physical inactivity and sedentary behavior during COVID-19. Front Public Health  2020; 8: 199.
 [http://dx.doi.org/10.3389/fpubh.2020.00199] [PMID: 32574294]

[54]
Klein R, Julian KA, Snyder ED, et al. Gender bias in resident assessment in graduate medical education: Review of the literature. J Gen Intern Med  2019; 34(5): 712-9.
 [http://dx.doi.org/10.1007/s11606-019-04884-0] [PMID: 30993611]
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DOI https://dx.doi.org/10.2174/1875692120666230811092856	Print ISSN 1875-6921
Publisher Name Bentham Science Publisher	Online ISSN 1875-6913
Current Pharmacogenomics and Personalized Medicine

Sex and Gender Differences in Medical Education: The Impact on Scientific Reports

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