Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science: A Scientific Statement From the American Heart Association.

1302 The Institute of Medicine has defined sex as “the classification of living things, generally as male or female according to their reproductive organs and functions assigned by the chromosomal complement.” The term sex means biological differences between women and men, including chromosomes, sex organs, and hormonal contributions. Sex differences result from true biological differences in the structure and function of the cardiovascular systems of men and women. In contrast, gender differences ensue from a person’s self-representation, resulting in psychosocial roles and behaviors imposed by society; gender implies social roles, behaviors, and cultural norms. Gender differences play a role in the treatment of cardiovascular disease (CVD) and affect outcomes, but they are very different from sex differences that arise from the genetic differences between men and women. Sex differences are a result of a single chromosomal difference between men (XY) and women (XX). Gender, however, is a social construct that differentiates men from women in a society as they assume their social roles. Gender develops on the basis of cultural norms and is articulated through values, perceptions, psychosocial characteristics, and behaviors. Sexand gender-specific science addresses how experiences of the same disease, for example, ischemic heart disease (IHD), are similar and different with respect to biological sex and gender. For instance, women tend to have smaller coronary arteries than men, and women have less obstructive IHD than men. However, gender differences, which are influenced by ethnicity, culture, and socioeconomic environment, are intimately involved in risk factors and risk behaviors (eg, psychosocial risk factors, physical inactivity [PI], cardiac rehabilitation participation, obesity, and tobacco use) that play a far greater role in outcomes among women with IHD than biological sex differences, given that 80% of heart disease is preventable. These differences affect the mechanism and expression of CVD between the sexes. Sex differences in the cardiovascular system are summarized in Table 1. During the past 2 decades, we have learned that sex differences exist in the pathophysiology of coronary heart disease, symptom presentation, efficacy of diagnostic tests, response to pharmacological interventions, and clinical outcomes of IHD. We have also learned that gender variations exist, such as delay in seeking treatment, which may also contribute to differences in clinical outcomes and mortality rates. Several milestones have contributed to the progress that has been made thus far (Table 2). These important milestones are instrumental