Canadian Journal of Cardiology

Sex/Gender and Allostatic Mechanisms of Cardiovascular Risk and Disease

Published:September 20, 2022DOI:


      Cardiovascular diseases are leading causes of mortality and morbidity in adults worldwide. Multiple studies suggest that there are clinically relevant sex differences in cardiovascular disease. Women and men differ substantially in terms of prevalence, presentation, management, and outcomes of cardiovascular disease. To date, however, little is known about why cardiovascular disease affects women and men differently. Since many studies do not differentiate the concept of sex and gender, it is sometimes difficult to discriminate what constitutes as sociocultural or biological contributors that drive observed clinical differences. Female sex has some biological advantages in relation to cardiovascular disease, but many of these advantages seems to disappear as soon as women develop cardiovascular risk factors (e.g., type 2 diabetes, hypertension, dyslipidemia). Furthermore, stress and allostatic load could play an important role in the relationship between sex/gender and cardiovascular diseases. In this narrative review, we argue that chronic stress and psychosocial factors might better encompass the patterns of allostatic load increases seen in women, while biological risk factors and unhealthy behaviors might be more important mechanisms that drive increased allostatic load in men. Indeed, men show allostatic load patterns that are more associated to impaired anthropometric, metabolic, and cardiovascular functioning while women have greater dysregulation in neuroendocrine and immune functioning. This gender-related factors might contribute to the pathogenesis of cardiovascular disease especially through stress mechanisms. It is important to continue to study the mechanisms in which gender influences chronic stress, because chronic stress could influence modifiable gendered factors to promote cardiovascular disease prevention.
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