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[english] Introduction: Knowledge derived from gender specific research is more and more integrated into the medical education. In Germany this process is developing with a certain delay compared to other Anglo-Saxon or Scandinavian countries. Our survey examines for the first time to what extend gender specific aspects have been integrated into the medical education at the Charite Universitaetsmedizin Berlin. Material and Methods: Topics like gender specific learning objectives and their implementation in the own field were evaluated by means of a standardized questionnaire, differentiated for professors, medical teachers and course coordinators as well as for sex in qualitative and quantitative categories. Results: 30 different fields of medicine took part in this study and revealed a number of important topics with gender specific differences. These contents are integrated into the medical education with relatively simple methods by 70% of the participating professors and medical teachers. In general there is only little interest in spending time for further qualification or the development of a curriculum for the field of gender medicine. Female participants of this study were significantly more interested in gender medicine aspects (p=0,017 development of the medical curriculum). Conclusion: This study underlines the need for official learning objectives containing gender differences during the medical education at the Charite Berlin. A great number of the teaching staff reveals a positive attitude towards these contents and integrates a lot of them. These efforts should be supported by more gender specific teaching material and personal investment into the curricular development. [german] Zielsetzung: Die Erkenntnisse der Geschlechterforschung finden zunehmend Eingang in die medizinische Ausbildung von ÄrztInnen. Dabei steht Deutschland verglichen mit vielen englischsprachigen und nordeuropäischen Ländern noch am Anfang einer Entwicklung. Die vorgelegte Bestandsaufnahme untersucht, welchen Stellenwert geschlechterspezifische Fragestellungen in der Lehre an der Charité Universitätsmedizin Berlin haben. Methodik: Mit Hilfe eines standardisierten Fragebogens wurden verschiedene Themenbereiche wie geschlechtsspezifische Lernziele und die Umsetzung im eigenen Fach quantitativ und qualitativ für ProfessorInnen, DozentInnen und LehrkoordinatorInnen sowie nach Geschlecht erfasst. Ergebnisse: 30 verschiedene Fächer haben an der Bestandsaufnahme teilgenommen und dabei eine Reihe von Themenkomplexen mit geschlechterspezifischen Unterschieden zusammengetragen. Bisher werden solche Themen nur mit relativ einfachen Mitteln in der Lehre durch etwa 70% der angeschriebenen ProfessorInnen und DozentInnen umgesetzt. Insgesamt besteht aber wenig Interesse der Lehrenden an zusätzlichem Zeitaufwand für Qualifizierung oder Curriculumsentwicklung in diesem Bereich. Die weiblichen Teilnehmenden standen dem Thema ‚Geschlechterunterschiede in der Medizin’ signifikant offener gegenüber (p=0,017 Interesse an Curriculumsentwicklung). Schlussfolgerung: Es gibt einen Bedarf an formulierten Lernzielen für Themenkomplexe mit Geschlechteraspekt im Curriculum des Medizinstudiums an der Charité Berlin. Eine Vielzahl von Lehrenden steht diesen Themenkomplexen offen gegenüber, unterrichtet solche Inhalte bereits und sollte in der Curriculumsentwicklung sowie mit Material bei der Umsetzung im Rahmen ihrer Lehrtätigkeiten unterstützt werden.

Author(s): Caroline E. Gebhard [sup.1] [sup.2], Nadia Hamouda [sup.3] [sup.6], Pimrapat Gebert [sup.4], Vera Regitz-Zagrosek [sup.5] [sup.6], Catherine Gebhard [sup.3] [sup.6] [sup.7] [sup.8], Susan Bengs [sup.3] [sup.6] [sup.7], Bianca Gysi [...]

Background: Presentations and outcomes of acute myocardial infarction (MI) differ between women and men, with the worst outcomes being reported in younger women. Mental stress induced ischemia and sympathetic activation have been suggested to play a prominent role in the pathogenesis of MI in younger women, however, the impact of sex hormones on these parameters remains unknown. Methods: The effect of sex hormones and age on myocardial infarct size and myocardial sympathetic activity (MSA) was assessed in male and female, as well as young (4–6 months) and aged (20–22 months) FVB/N mice (n = 106, 60 gonadectomized and 46 sham-operated animals) who underwent in vivo [11C]meta-hydroxyephedrine ([11C]mHED) positron emission tomography (PET) and cardiac magnetic resonance (CMR) imaging 24 h after a 30 min myocardial ischemic injury. Results: MSA and catecholamine levels following myocardial injury were highest in young males (p = 0.008 and p = 0.043 vs. young females, respectively) and were reduced by orchiectomy. Accordingly, testosterone serum levels correlated positively with MSA (r = 0.66, p < 0.001). Males had a larger average infarct size and lower left ventricular contractility following myocardial injury than females (p < 0.05 vs. females). These sex differences were no longer evident in gonadectomized animals (p = NS vs. females). In female animals, estrogen depletion did not affect MSA (ovariectomy effect, p = 0.892). Female animals showed an age-dependent increase in MSA (p = 0.011), which was absent in males. Conclusion: Testosterone associates with an increase in sympathetic tone, contributing to adverse cardiac remodeling following MI. Conversely, females maintain sympathetic integrity, independent of sex hormones. Our results suggest a biological advantage of female sex in post MI recovery. Further research is warranted to confirm these findings in humans. Plain English Summary: Heart attacks affect men and women differently, with younger women often experiencing worse outcomes than men. One reason for this difference might be how stress and heart nerve activity are influenced by sex hormones, though this has not been well understood to date. In this study, we investigated how sex hormones and age affect heart damage and nerve activity in male and female mice. We used advanced imaging techniques to look at the hearts of young and older mice, some of which had their sex organs removed to study the hormone effects. Our results showed that young male mice had higher nerve activity and stress hormone levels after a heart attack compared to young female mice. Removing the male sex hormone (testosterone) reduced this activity, suggesting testosterone worsens heart damage. In contrast, removing female sex hormones (oestrogen and progesterone) did not affect nerve activity in female mice. Females also maintained better heart function after a heart attack, regardless of their hormones. In summary, male sex hormones may worsen early heart attack recovery by increasing stress on the heart, while female hearts were more resilient in our study. This information could help refine risk stratification and treatment of heart attack in men and women. Highlights: In a validated murine model of acute myocardial infarction (MI), young males show higher myocardial sympathetic activity (MSA) and stress hormone levels compared to their female counterparts. Circulating testosterone levels correlated with an enhanced MSA post MI in males. Female mice maintain better heart function after a heart attack, regardless of estrogen levels. Sex differences in MI outcomes are eliminated when sex hormones are removed. These findings highlight a potential protective role of female sex in post MI recovery. [ABSTRACT FROM AUTHOR]

The document titled "2024 ESC Guidelines for the management of elevated blood pressure and hypertension" provides comprehensive guidelines for the management of high blood pressure and hypertension. It covers various topics such as the pathophysiology and clinical consequences of elevated blood pressure, methods for measuring blood pressure, risk assessment for cardiovascular disease, diagnosing hypertension and investigating underlying causes, prevention and treatment strategies, managing specific patient groups or circumstances, acute and short-term blood pressure management, and patient-centered care. The guidelines aim to provide evidence-based recommendations for healthcare professionals in order to improve the management and prevention of hypertension and its associated complications. [Extracted from the article]

Background: Aging and comorbidities like type 2 diabetes and obesity contribute to the development of chronic systemic inflammation, which impacts the development of heart failure and vascular disease. Increasing evidence suggests a role of pro-inflammatory M1 macrophages in chronic inflammation. A shift of metabolism from mitochondrial oxidation to glycolysis is essential for the activation of the pro-inflammatory M1 phenotype. Thus, reprogramming the macrophage metabolism may alleviate the pro-inflammatory phenotype and protect against cardiovascular diseases. In the present study, we hypothesized that the activation of estrogen receptors leads to the elevation of the mitochondrial deacetylase Sirt3, which supports mitochondrial function and mitigates the pro-inflammatory phenotype in macrophages. Materials and Methods: Experiments were performed using the mouse macrophage cell line RAW264.7, as well as primary male or female murine bone marrow macrophages (BMMs). Macrophages were treated for 24 h with estradiol (E2) or vehicle (dextrin). The effect of E2 on Sirt3 expression was investigated in pro-inflammatory M1, anti-inflammatory/immunoregulatory M2, and naïve M0 macrophages. Mitochondrial respiration was measured by Seahorse assay, and protein expression and acetylation were determined by western blotting. Results: E2 treatment upregulated mitochondrial Sirt3, reduced mitochondrial protein acetylation, and increased basal mitochondrial respiration in naïve RAW264.7 macrophages. Similar effects on Sirt3 expression and mitochondrial protein acetylation were observed in primary female but not in male murine BMMs. Although E2 upregulated Sirt3 in naïve M0, pro-inflammatory M1, and anti-inflammatory/immunoregulatory M2 macrophages, it reduced superoxide dismutase 2 acetylation and suppressed mitochondrial reactive oxygen species formation only in pro-inflammatory M1 macrophages. E2 alleviated the pro-inflammatory phenotype in M1 RAW264.7 cells. Conclusions: The study suggests that E2 treatment upregulates Sirt3 expression in macrophages. In primary BMMs, female-specific Sirt3 upregulation was observed. The Sirt3 upregulation was accompanied by mitochondrial protein deacetylation and the alleviation of the oxidative and pro-inflammatory phenotype in M1 macrophages. Thus, the E2–Sirt3 axis might be used in a therapeutic strategy to fight chronic systemic inflammation and prevent the development of inflammation-linked diseases. [ABSTRACT FROM AUTHOR]

Myocarditis is an inflammatory disease that may lead to dilated cardiomyopathy. Viral infection of the myocardium triggers immune responses, which involve, among others, macrophage infiltration, oxidative stress, expression of pro-inflammatory cytokines, and microRNAs (miRNAs). The cardioprotective role of estrogen in myocarditis is well documented; however, sex differences in the miRNA expression in chronic myocarditis are still poorly understood, and studying them further was the aim of the present study. Male and female ABY/SnJ mice were infected with CVB3. Twenty-eight days later, cardiac tissue from both infected and control mice was used for real-time PCR and Western blot analysis. NFκB, IL-6, iNOS, TNF-α, IL-1β, MCP-1, c-fos, and osteopontin (OPN) were used to examine the inflammatory state in the heart. Furthermore, the expression of several inflammation- and remodeling-related miRNAs was analyzed. NFκB, IL-6, TNF-α, IL-1β, iNOS, and MCP-1 were significantly upregulated in male mice with CVB3-induced chronic myocarditis, whereas OPN mRNA expression was increased only in females. Further analysis revealed downregulation of some anti-inflammatory miRNA in male hearts (let7a), with upregulation in female hearts (let7b). In addition, dysregulation of remodeling-related miRNAs (miR27b and mir199a) in a sex-dependent manner was observed. Taken together, the results of the present study suggest a sex-specific expression of pro-inflammatory markers as well as inflammation- and remodeling-related miRNAs, with a higher pro-inflammatory response in male CVB3 myocarditis mice. [ABSTRACT FROM AUTHOR]

While numerous studies have confirmed a causal association between lipoprotein(a) [Lp(a)] and cardiovascular diseases, only a few studies have assessed the relationship between Lp(a) and pulmonary health, with inconsistent findings regarding this topic. This study's aim was to examine whether levels of serum Lp(a) are associated with lung function in a dataset of relatively healthy older adults. We used longitudinal data collected at two time points 7.4 ± 1.5 years apart from 679 participants (52% women, 68 [65–71] years old) from the Berlin Aging Study II (BASE-II). Multiple linear regression models adjusting for covariates were applied to examine the association between Lp(a) and lung function. The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) were higher in both men and women with higher Lp(a) levels. However, since this association between lung function parameters and Lp(a) was not supported by Mendelian randomization analyses using recent genome-wide association study data, these relationships should be investigated in future work, as the observed differences are, in part, considerable and potentially clinically relevant. [ABSTRACT FROM AUTHOR]

Author(s): Eva Gerdts [sup.1] , Vera Regitz-Zagrosek [sup.2] [sup.3] Author Affiliations: (1) Department of Clinical Science, University of Bergen, Bergen, Norway (2) Berlin Institute for Gender in Medicine, Charité Universitätsmedizin, [...], The prevalence of cardiometabolic disorders in both women and men has increased worldwide and is linked to a rise in obesity and obesity-associated associated clustering of other cardiometabolic risk factors such as hypertension, impaired glucose regulation and dyslipidemia. However, the predominance of common types of cardiometabolic disorders such as heart failure, atrial fibrillation and ischemic heart disease is sex specific, and our identification of these and the underlying mechanisms is only just emerging. New evidence suggests that sex hormones, sex-specific molecular mechanisms and gender influence glucose and lipid metabolisms, as well as cardiac energy metabolism, and function. Here we review sex differences in cardiometabolic risk factors, associated preclinical and clinical cardiac disorders and potential therapeutic avenues. Sex differences in the prevalence, risk factors and symptoms of cardiometabolic disorders are being elucidated and should be taken into account in diagnosis and treatment.