Pedro Armario García, Carmen Suárez Fernández and José Ignacio Cuende Molero.
The ecardiovascular diseases they are manifested to a greater extent, and in a historical way, in women. However, medicine has not yet been able to provide scientific evidence of why this phenomenon occurs. A “scientific” absence that you now see in the hplacental compensation hypothesis a new way to go to explain the sexual differentiation of this pathology.
“The theory of lPlacenta compensation is a line of work that could provide evidence in gender differentiations ”, highlights José Ignacio Cuende Molero, internist at the Palencia Healthcare Complex during the 42nd National Congress of the Spanish Society of Internal Medicine (SEMI).
The specialist considers that women have more intense immune responses than men, so they have infections with a better prognosis, but they have more autoimmune processes. In addition, it ensures that scientific evidence shows that diagnostic evaluation of autoimmune diseases and treatment is different in women based on three concepts: sex hormones, environmental factors and genetics.
“The theory states that natural evolution to the human species has led to the chromosomal sex differentiation, which could justify the greater autoimmunity of women and fewer non-sex-dependent cancers “, explains Cuende Molero, during the table ‘Cardiovascular Risk in special populations”, which also included Pedro Armario García, internist at the Sant Joan Despí Hospital Moisés Broggi and with Carmen Suárez Fernández, internist at La Princesa University Hospital.
What is the hypothesis of placental compensation?
The hypothesis of placental compensation states that the evolution of placentation exerted a significant sex-specific selection in the immune system for tolerate fetal antigens while the pregnant woman defends herself against parasites and pathogens. “It downregulates the immune system to the fetus and upregulates specific immune systems to continue protecting itself from pathogens,” explains Cuende Molero.
However, the change to an industrialized environment transforms the paradigm. “The lower number of pregnancies causes a decrease in the immune system and an increase in autoimmune diseases and tumors. In addition, there are interrelationships between hormonal levels and immune control ”, details the internist.
A moment from the table ‘Cardiovascular Risk in special populations’
Increase in the prevalence of HT in young people
Other novelties in cardiovascular risks is the increased prevalence in young people of Arterial Hypertension (HTN), a disease linked to increasing age. As detailed by Armario García, in young subjects (18-39 years old) an increase in prevalence has been observed and it already oscillates between the 7 and 18 percent, being more frequent in males. “In this age group, and in relation to optimal blood pressure (BP), normal-high BP with an increase in vascular risk of 75 percent and established HT triples said risk.”
Therefore, the specialist considers “Essential” to confirm the diagnosis of hypertension by ambulatory BP measurement and ruling out secondary HT in those under 30 years of age with a historical parental absence of HT and signs or symptoms suggestive of secondary HT.
Regarding treatment, Armario García considers that for the group with hypertension and hyperkinesia (increased cardiac output and tachycardia), beta-blockers should be started and warns that a delay in the start of treatment would imply a higher prevalence of early target organ involvement and an increased risk of developing a cardiovascular event. In addition, he makes special mention of pregnant women. “The use of IEACAS or ARA 2 would be contraindicated in pregnancy, and it must always be borne in mind that up to 50 percent of pregnancies are not planned,” warns the internist.
How are the cardiovascular risks in people over 90 years of age?
For his part, Suárez Fernández has addressed cardiovascular risks in nanogenarians. “Along with covid is the great 21st century epidemic. In Spain they have increased by 250 percent in the last 20 years, going from 200,000 to almost 600,000 ”, details the internist, who assures that the most frequent disease in these ages is cerebrovascular although the first cause of death is infections.
After reviewing the scientific literature, the specialist assures that as nanogenarians have more years have a better cardiovascular profile. “The prevalence decreases in all factors. In addition, the older they are, the less they use health systems, ”explains Suárez Fernández, for whom it is not age but rather comprehensive geriatric assessment which should guide decisions and advocates not withdrawing an already established and well-tolerated treatment.
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