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INNOSC Theranostics and
Pharmacological Sciences The Takotsubo syndrome: A gender disparity

to be affected by emotional events. By breaking down as a result of this illness. The elevated catecholamine
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the total number of TTS cases by gender, it is possible to level is thought to be the cause of the left ventricular
determine that the notable variation in TTS prevalence dysfunction, electrocardiogram abnormalities, band
between men and women is also a result of the social necrosis, and hypercontraction of sarcomas that are
standing and roles that women play in various nations and indistinguishable from TTS. 36
cultures. These triggers can happen alone or in combination; (ii) Coronary artery disease (CAD), which has a
for example, a panic attack or an emotional event that prevalence of 10 – 29%, is frequently linked to TTS.
follows surgery or an accident can trigger anxiety. According to some theories, CAD and TTS coexist
or CAD even act as a trigger for the development of
2.1.1. Stressors on an emotional level TTS. 37-39
Anxiety, fear, anger, earthquakes, floods, interpersonal
conflicts, and traumatic experiences are just a few 3. Gender disparities in TTS
examples of the wide range of emotions and situations that When comparing the gender distribution of TTS cases in
can be described as “stressors”. 23-26 An important aspect the USA, Europe, and Japan, it is important to note that
of this process is the identification of psychological and while the percentage of male cases varies from study to
psychosocial stressors. There is very little information about study, TTS affects women more often than men. Of note,
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the living conditions of patients with TTS at the moment. TTS affects particularly postmenopausal women. 40
The study by Wallstrom et al. examined the psychological
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and psychosocial stress experienced by postmenopausal This is in opposition to how the illness manifests itself:
women. Many of the patients reported that they felt accumulating evidence points out that men are frequently
burdened by responsibility, injustice, and uncertainty long more severely affected by TTS than women. Taking into
before the onset of TTS. The respondents’ defenses were account the gender disparities in the USA, Europe, and
so weakened by this prolonged stress that even minor Japan, recent reports suggest that women tend to respond
stressors could cause them to lose their equilibrium. The more to emotional stressors, while men respond primarily
findings suggest that the respondents’ circumstances may to physical stressors (Figure 1).
also be influenced by the gender-based social structure. Since TTS is a relatively uncommon disease, the
The large proportion of female respondents could be a only sources of data available at this time are the Tokyo
reflection of these factors. Cardiovascular Care Unit, the International Takotsubo
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41
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Furthermore, it should be noted that even situations Registry, the US National Inpatient Sample Registry, and
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associated with pleasant emotions such as weddings, the Cardiovascular Research Consortium-8 Universities.
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surprise parties, and employment offers can serve as Actually, according to the Tokyo Cardiovascular Care Unit,
stressors. These various emotional stressors could all be male patients (50%) are more likely than female patients
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regarded as TTS triggers. When it comes to stressors, the (31.3%) to have experienced prior physical stress. On the
severity of a single incident or the confluence of multiple other hand, female patients experience emotional stress
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relatively insignificant emotions likely matters more than at a higher rate than male patients (19.0% vs. 31.0%).
the specific type of emotion. In detail, according to reports from the International
Takotsubo Registry, 29.2% of females and about 14.5%
2.1.2. Stressors on a physical level
The development of TTS is significantly influenced not
only by emotional but also by physical stress factors. These 16%
physical stressors therefore include incredibly strenuous 28%
activities and illnesses, such as surgery, traumatic 31% emotional stress
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injuries, radiotherapy, sepsis, or even pregnancy, Female
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32
30
drug addiction, and disorders of the neurological system. 32% physical stress
However, the occurrence of TTS has so far been primarily absence of stress
associated with conditions like intracerebral hemorrhage,
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seizures, stroke, and head trauma. 35 37%
29
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56%
Moreover, the following two conditions could be linked Male
to TTS:
(i) An adrenal gland’s enterochromaffin cells give rise Figure 1. Prevalence of emotion and physical stressors leading to
to pheochromocytoma, a neuroendocrine tumor. It Takotsubo syndrome among female (inner circle) and male individuals
has been proposed that catecholamines are released (outer circle)
Volume 7 Issue 4 (2024) 3 doi: 10.36922/itps.3142