Looking Beyond Binary Sex Classifications: Gender-Related Variables in Patients Entering Cardiac Rehabilitation

Coronary artery disease (CAD) is a leading cause of death worldwide. There are known differences in the clinical and sociodemographic characteristics of males and females with CAD, such as higher mortality and poorer health-related quality of life (HR-QoL) following a revascularization procedure in females.1 Sex (i.e., males, females, intersex) is a biological construct, while gender encompasses socially-constructed roles, behaviors and self-expressions. When gender-related variables are included in analyses, post-revascularization sex-differences are often attenuated.2 Differences in health status and HR-QoL of patients with CAD may be better explained by considering gender-related variables (e.g., gender-identity, education and marital status) rather than biological sex alone.2,3,4

At cardiac rehabilitation (CR) entry, patients with CAD who have undergone coronary revascularization procedures frequently demonstrate low functional capacity, levels of physical activity and HR-QoL.5 Existing CR research is limited in investigating the independent effects of gender-related variables on functional capacity and HR-QoL. The purpose of this study was to examine the associations between gender-related variables and health-status indicators (i.e., functional capacity and HR-QoL) at CR entry.