On inquiring ideas of epidemic proportions...

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Thursday, January 19, 2006

Sex-Specific Investigations into Etiology

Recently, epidemiology and medicine have begun to focus more and more on sex-specific etiologies for disease. Men and women may not necessarily be as far apart as Mars and Venus... however, it is becoming more and more clear that not all drugs act the same in men and women, and not all conditions lead to other diseases with the same rate in both sexes.

Simultaneously this week, two large meta-analyses clearly demonstrate that the above is likely true. Notably, the study by Berger et al. showed that aspirin has different effects on the primary prevention of stroke and myocardial infarction between the sexes. Additionally, the study by Huxley showed that diabetes is more adverse in women than men for CHD mortality-- diabetes may be considered a "CHD equivalent", but likely more so in women. Additionally, another study in AJE this week shows that fetal sex differentially influences maternal asthma.

These studies highlight the need for sex-based medicine. These studies also show that epidemiologic research likely always requires a synthesis of knowledge from a variety of populations-- one study cannot prove a disease pattern, and one diesease pattern cannot be generalized to all populations.

Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men: A Sex-Specific Meta-analysis of Randomized Controlled Trials
JAMA. 2006;295:306-313
Jeffrey S. Berger; Maria C. Roncaglioni; Fausto Avanzini; Ierta Pangrazzi; Gianni Tognoni; David L. Brown

Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies
BMJ 2006;332:73-78
Rachel Huxley, Federica Barzi, Mark Woodward

Effect of Fetal Sex on Airway Lability in Pregnant Women with Asthma
American Journal of Epidemiology 2006 163(3):217-221
Helen L. Kwon, Kathleen Belanger, Theodore R. Holford and Michael B. Bracken

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