Gender differences in cardiovascular disease and comorbid depression.

Although gender is increasingly perceived as a key determinant in health and illness, systematic gender studies in medicine are still lacking. For a long time, cardiovascular disease (CVD) has been seen as a "male" disease, due to men's higher absolute risk compared with women, but the relative risk in women of CVD morbidity and mortality is actually higher. Current knowledge points to important gender differences in age of onset, symptom presentation, management, and outcome, as well as traditional and psychosocial risk factors. Compared with men, CVD risk in women is increased to a greater extent by some traditional factors (e.g., diabetes, hypertension, hypercholesterolemia, obesity), and socioeconomic and psychosocial factors also seem to have a higher impact on CVD in women. With respect to differences in CVD management, a gender bias in favor of men has to be taken into account, in spite of greater age and higher comorbidity in women, possibly contributing to a poorer outcome. Depression has been shown to be an independent risk factor and consequence of CVD; however, concerning gender differences, the results have been inconsistent. Current evidence suggests that depression causes a greater increase in CVD incidence in women, and that female CVD patients experience higher levels of depression than men. Gender aspects should be more intensively considered, both in further research on gender differences in comorbid depression, and in cardiac treatment and rehabilitation, with the goal of making secondary prevention more effective.