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Chapter 7: Chronic Conditions and Medication Response

Anisha B. Grover; Nima M. Patel-Shori; Jennifer L. Andres; Danielle C. Mayer; Martha Stassinos

LEARNING OBJECTIVES

  1. Explain sex and gender influence on health and disease in select chronic conditions.

  2. Explain sex and gender differences in medication response for select chronic conditions.

  3. Summarize literature pertaining to chronic diseases that impact women's health.

  4. Compare and contrast prevention and treatment interventions for select chronic conditions between women and men.

INTRODUCTION

To achieve optimal pharmacotherapy in women, health care providers must understand the impact of sex and gender on disease presentation and effectiveness and safety of medications. Presently, the scientific evidence has documented many sex/gender differences that are clinically important to health care providers. This chapter is an overview of some sex/gender differences emphasizing chronic diseases and medication response based upon available data. Examples of some of the concepts discussed below are listed in Tables 7-1, 7-2, 7-3.

Table 7-1Examples of Sex and Gender Differences in Disease Prevalence
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Table 7-1 Examples of Sex and Gender Differences in Disease Prevalence
Diseases More/Greater Than Men Less/Smaller/Fewer Than Men Referencesa
Cardiovascular Stroke and mortality with atrial fibrillation, hospital mortality with acute coronary syndrome, mortality after acute myocardial infarction, strokes with more poststroke depression Obstructive heart disease, hypertension in young female adult years 2, 4, 5, 10, 32
Gastrointestinal disorders

Irritable bowel syndrome, Crohn’s disease, obesity

 Ulcerative colitis 47, 51, 53, 54, 64
Mental health Depression, anxiety   68, 69
Substance abuse In younger female adults, alcoholism Illicit medication use 88, 89, 105
Autoimmune diseases Rheumatoid arthritis   114
Bone and joint Osteoporosis; hand, foot, and knee osteoarthritis Mortality after osteoporotic fracture, hip osteoarthritis 125, 130
Neurologic disorders Multiple sclerosis, chronic fatigue syndrome Epilepsy 164

aReferences as appearing in text.

Table 7-2Examples of Sex Gender Differences in Disease Physiology and Pathophysiology
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Table 7-2 Examples of Sex Gender Differences in Disease Physiology and Pathophysiology
  More/Greater Than Men Less/Smaller/Fewer Than Men Referencesa
Cardiovascular Heart rate; impact of autoimmune diseases; altered presentation of strokes with more pain, headache, and mental changes Heart and coronary arteries, chest pain with ischemia 1, 2, 5, 14, 33, 34
Mental health Suicidal attempts, different neural circuits Suicidal deaths, downregulation of negative emotional reactions to fear and stress 66, 69
Substance abuse disorders Nicotine dependence onset; adverse effects from alcohol such as sexual dysfunction, liver cirrhosis, and cardiomyopathy Alcohol dehydrogenase 75, 80, 90, 92, 96, 97
Autoimmune disorders Immune reactivity   115
Bone and joint Tibial and patellar cartilage loss, obesity effect on joints Knee cartilage volume 130
Neurologic disorders Earlier onset of multiple sclerosis Progression of multiple sclerosis to disability 154, 155

aReferences as appearing in text.

Table 7-3...

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