May 26, 2020

COVID-19 – Why the gender disparity?

Over the last few weeks there has been a lot of speculation over what exacerbates an individual’s response to coronavirus and why there is such great disparity in the gender of those dying from this virus.

One explanation being explored is the effect of Angiotensin Converting Enzyme 2, or ACE2 on COVID-19.

ACE2 is naturally found in the cell membranes of our lungs, heart, intestines, blood vessels etc and facilitates the entry of things from the outside of the cell to the inside of the cell, by a process of endocytosis (the movement of the cell membrane to encapsulate an entity). ACE2 molecules cause the widening of blood vessels, resulting in reduced blood pressure.

The crown (or corona) structures on the virus surface bind to these ACE2 molecules, causing the transportation of the virus into cells. In this environment the virus can replicate effectively using the cell’s reproductive mechanisms. The high binding capacity of this new coronavirus to ACE2 enzymes means that the virus can very easily get into the body and thus is highly infectious.

There is considerable belief that ACE2 could play a part in explaining the increased fatality rates in males compared to females. In a study comprising two sample populations with heart disease, it was deduced that men had much higher levels of ACE2 than women with the same condition. The larger the quantity of ACE2 available, the higher the amount of viral molecules transported into cells and the greater the chance of infection.

Furthermore, considering that ACE2 is responsible for maintaining blood pressure it is also plausible that COVID-19 could affect those with hypertension (high blood pressure). This could again explain the gender divide as males are more likely to develop hypertension than females. In fact, two drugs to treat hypertension can also affect ACE2 – these are known as ACE inhibitors. In animal studies both these drugs caused an increased production of ACE2 and therefore could result in a more severe reaction to COVID-19.

Despite this, independent studies at a smaller scale have suggested that not taking hypertension medication is more dangerous than taking these drugs. It is because of these studies that healthcare professionals and professional bodies are encouraging individuals to keep taking their medicines as prescribed and on time.

The importance of social distancing for high-risk groups like those with hypertension cannot be emphasised enough. The risks that this virus poses must not be forgotten as the social restrictions are lifted internationally. The need for people to stay in control of their health and their medicines has never been more important.




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