Men need more than medicine for their cardiovascular health

There is a strong focus on the biological differences between men and women that contribute to differences in cardiovascular disease¹, the effects of the medicines used for treatment², and the prevalence of traditional biological risk factors  (e.g. high blood pressure, obesity, smoking) for cardiovascular disease³. However, there are psychosocial and sociological determinants of cardiovascular health that need to be considered to ensure appropriate and effective health care.

Cardiovascular disease accounts for 14% of Australia’s total burden of disease, but this is borne disproportionately across our population. Cardiovascular disease causes an increasing burden with age, to be the greatest contributor to disease burden in those aged over 70. When adjusted for age and population, cardiovascular disease causes 30.6 disability-adjusted life years (DALYs) per 1000 Australian males (15.1% of total DALY), and 16.8 DALYs/1000 females. The cardiovascular disease burden also varies by geographic location, distance from services (e.g. major cities, outer regional) and socioeconomic status⁴.

The variations in DALYs that are attributable to cardiovascular disease reflect differences in the prevalence of cardiovascular disease and its health impacts between different population groups. The fact that social factors (e.g. distance from services, socioeconomic status) influence the burden of cardiovascular disease demonstrates that variations in prevalence and severity are not due simply to biology.

Psychosocial factors contribute around one-third of the risk for cardiovascular disease⁵. There psychological and sociological determinants of cardiovascular health affect men and women differently. The benefit to cardiovascular health of marriage, for example, is different between males and females. An individual’s perception of a ‘positive’ marriage benefits women’s cardiovascular health more than men’s, and a ‘negative’ marriage affects women’s cardiovascular health but not men’s⁶.

Psychosocial factors may have a greater influence on cardiovascular disease than traditional biological risk factors. ‘Vital exhaustion’, which is characterised by profound fatigue, irritability and demoralisation, was the highest-ranked cardiovascular disease risk factor in men (and second highest in women) in a large Dutch study⁷.

The pathogenesis of cardiovascular disease can originate very early in life, and the influence of etiological factors accumulates over time. This means that contributors to the development of cardiovascular disease act across the lifespan, and this is true for psychosocial⁸ and traditional biological risk factors⁹.

Just as biological differences between the sexes influence cardiovascular disease risk, so too do gender differences. Gender norms influence the development of stereotypical health behaviours in males and females and result in different exposures to psychosocial risk factors for cardiovascular disease throughout life. For example¹⁰:

• Physical activity is encouraged more in males from very early in life, whereas legitimate fears of harassment or abuse of females discourage physical activity
• Social support may decline throughout adolescence for males, resulting in high rates of illicit drug use and psychological traits associated with higher rates of cardiovascular disease
• Cigarette smoking is used to control body weight by almost half of adolescent females, and nearly one-third of adolescent males
• Early life physical and sexual abuse, which causes abnormal immune, neurological and endocrine function associated with cardiovascular disease, occurs in 1 in 6 Australian females and 1 in 10 males¹¹
• Work, home and financial stress are generally shared unequally between males and females.

There’s little doubt about the importance of psychosocial factors in the development of cardiovascular disease, but robust evidence to support specific interventions to address these is lacking¹².

The German Cardiac Society recommends a person-centred approach that considers a patient’s age, gender, and preferences for diagnosis and treatment options. They provide these useful recommendations for treatment of people with psychosocial risk factors for cardiovascular disease¹¹: