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Karin Schenck-Gustafsson, MD, PhD, FESC: Why Sex and Gender Must be Considered in Disease Treatment

Karin Schenck-Gustafsson, MD, PhD, FESC, explains why sex and gender must be taken into account when treating and managing patients with rheumatic disease from a cardiologist's perspective.

Rheumatology Network interviewed Karin Schenck-Gustafsson, MD, PhD, FESC, to discuss her recent European Alliance of Associations for Rheumatology (EULAR) 2022 conference presentation “Why sex and gender must be taken into account.” Schenck-Gustafsson is Professor of Cardiology and a Senior Consultant at Karolinska Institutet and Karolinska University Hospital in Sweden.

Rheumatology Network: What are some of the benefits of including sex and gender when deciding how to treat patients?

Karin Schenck-Gustafsson, MD, PhD, FESC: It’s more than a benefit– I would say it's a matter of life and death. Usually, it's predominantly women that aren't included in the studies. This is especially prevalent in my area, cardiology, but it’s everywhere. However, it could be very bad for men as well.

RN: What were the key findings of your presentation?

KSG: In cardiology, specifically, if you don't include women, they can die if they don't get the proper treatment. For example, in myocardial infarction, women don't have the “typical” symptoms that men have. When you have a myocardial infarction, you need urgent care and need to be quickly taken to the hospital. There are Swedish studies, and other studies, that show that if a woman calls an ambulance, there is a delay when compared with men. Also, when a woman comes into the hospital with “atypical” symptoms, she is more likely to be placed in an ordinary ward instead of the coronary intensive care unit.

When I was Director of the coronary intensive care unit at the Karolinska hospital, I saw that women were being mistreated. They could have electrocardiogram (ECG) changes and could have blood samples indicating myocardial infarction, but when they received an X-ray it was normal. Now, we know that you can have myocardial infarction without obstruction in the coronaries, which is most more common in women.

Evaluating sex and gender is also important for men because of aspects like depression. Men may be underdiagnosed when it comes to depression. In fact, more men take their lives when compared with women. Perhaps this could be prevented if they were able to receive antidepressants and/or other therapies.

RN: Do you plan on doing any further research on this topic?

KSG: Absolutely. I've built a database databank and, for several years, we’ve been working on analyzing all registered drugs in Sweden. We then examine whether there is a sex analysis, and in many cases, there is no sex analysis determining if women and men should have different treatment. We have found a lot of differences, including side effects.

Additionally, I'm writing a study about heart palpitations, which are much more common in women than men. We analyzed 1000 women, and among women having palpitations, up to 4-5% had atrial fibrillation or other dysrhythmias. Those who weren’t presenting dangerous symptoms were able to view that information via a mobile phone app, which in turn alleviated their stress. Our questionnaires verified that data. 

RN: Is there anything else that you'd like our audience to know?

KSG: There are many conditions in rheumatology, and other autoimmune diseases, which differ between men and women. It's important to look into that.