Guido Falcone, MD, Department of Neurology, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina.
Ji Y. Chong, MD, Assistant Professor of Neurology, Columbia University, New York, NY, U.S.A.

Stroke is a common disease in the older population. Many gender differences are seen in the epidemiology, outcomes, and treatment of geriatric stroke. Although these differences are not fully understood, recognition of gender differences may help with appropriate treatment and improve outcomes.
Key words: stroke, gender, outcomes, prevention, treatment.

Bridget K. Gorman, PhD, Assistant Professor, Department of Sociology, Rice University, Houston, TX, USA.
Jen’nan Ghazal Read, PhD, Assistant Professor, Department of Sociology and Center for Health Policy Research, University of California, Irvine, CA, USA.

Men have shorter life expectancies than women in most nations around the world. The gender gap in mortality is particularly striking in high-income industrialized nations such as the United States, where women were expected to live 5.3 years longer than men in 2003 (80.1 years compared to 74.8 years). However, in recent decades this gap has been steadily shrinking in many nations. This review examines the mortality gap, primarily in the U.S. context, by providing an overview of the gender pattern in mortality, an explanation of its existence, and an assessment of how and why it has changed over time.
Key words: mortality, life expectancy, gender, smoking, cigarettes.

Nahid Azad, MD, Associate Professor, Faculty of Medicine, University of Ottawa, Ottawa, ON.
Arlene S. Bierman, MD, MS, FRCPC, Ontario Women’s Health Council Chair in Women’s Health, Centre for Research on Inner City Health, St. Michael’s Hospital; Faculties of Medicine and Nursing, University of Toronto, Toronto, ON.

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality for both men and women. Among individuals with coronary heart disease (CHD), there are gender differences in clinical epidemiology, prevalence of risk factors, clinical presentation, and quality and outcomes of care. Older adults and older women in particular are at risk for underdiagnosis and suboptimal management of CHD and its risk factors. Adherence to clinical practice guidelines for diagnosis and management of CHD can improve outcomes of care for older men and women with CHD and narrow gender disparities in clinical outcomes.
Key words: cardiovascular disease, gender, older adults, quality of care, women’s health, coronary heart disease.

Silja Majahalme, MD, PhD, FESC, Cardiologist and Clinical Hypertension Specialist, Appleton Heart Institute/Appleton Cardiology Associates, Appleton, WI, USA.

Heart failure (HF) is an increasing problem in the older adult population, specifically among women. The majority of health care expenses are generated in the last few years of life, and hospitalization for HF is one of the major medical conditions influencing the expenditure. The nature of women’s HF differs from men: coronary artery disease is the most common etiologic factor for HF in men while women more often suffer from hypertensive heart disease, which results in stiffness of the left ventricle with relaxation problems, and diastolic HF. Most commonly there is a long history of poorly controlled hypertension. In acute situations these patients often present with florid edema and congestion along with significantly elevated blood pressure levels, which are both challenging to treat. This short review covers issues related to gender differences in etiology and epidemiology of HF, and evaluates current evidence for drug therapies.
Key words: epidemiology, heart failure, gender, myocardial infarction, hypertension.

Jocalyn P. Clark, MSc

A recent article published in a special issue of the Canadian Medical Association Journal on Diversity and Women's Health described poor inclusion and representation of women in clinical drug trials for treatment of myocardial infarction (MI). Despite heart disease being a leading cause of disability and death among North American women, especially older women, less than one-quarter of the patients included in the studies were women and the average age of participants was only 62 years. The work of Rochon and colleagues at the University of Toronto extends earlier findings of Gurwitz et al. at the University of Massachusetts who reviewed the literature for a 30 year period up to 1991 and found that women represented only 20% of MI drug trial participants. Most of these trials excluded patients over the age of 75 years. Traditionally, older people have been poorly represented in clinical trials because they are more difficult to study: they tend to have coexisting illnesses, they use other medications that may interact with study drugs, and the elderly are more vulnerable to adverse drug effects. Additional reasons for explaining women's exclusion include fear of harming a fetus, hormonal fluctuations that may complicate responses to medication, and the use of estrogens which may be protective for some diseases.