title: Sex Differences in Type-2 Diabetes: Implications for Cardiovascular Risk Management.
abstract: Among individuals with Type 2 diabetes (T2DM), cardiovascular disease (CVD) is the leading cause of morbidity and mortality. Sex and gender differences (SGDs) in the cardiovascular consequences of T2DM are relevant suggesting the need for a more aggressive CVD preventive strategy in diabetic women as they lose the so-called &amp;quot;female advantage&amp;quot; in terms of CVD risk comparing with the nondiabetic population. Multiple factors may explain the disproportion in CVD risk among women with diabetes comparing with diabetic men or non-diabetic women. Both genetic and hormonal factors only partially explain SGDs in CVD risk in diabetes. However, women likely reach diagnosis later and in worse conditions, they undergo both diagnostic and therapeutic supports in lower percentage and, finally, they are not able to obtain therapeutic goals recommended by guidelines. Concerning the cardiovascular system, diabetes amplifies the extent of damage at both micro- and macrovascular level differently among sexes.
  
  
  
  The aim of this review is to clarify, in a sex and gender perspective, the impact of diabetes in CVD risk and to summarize the most important SGDs in CVD primary and secondary prevention strategies such as antiplatelet drugs and statins.
  
  
  
  The efficacy of ASA and/or statins in secondary prevention is documented in both sexes independently by the presence of T2DM. A different approach to CVD primary prevention with ASA using the age cut-off to discriminate sex differences has been recommended. The use of statins for primary prevention in women should be accurately monitored for the occurrence of myalgia and risk of developing diabetes.
  
  
  
  A gender approach in CVD prevention strategies is urgently required to achieve a sensible reduction of adverse CV events.
authors.affiliation: Department of Experimental Medicine, Sapienza University of Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Raparelli
authors.affiliation: Department of Experimental Medicine, Sapienza University of Rome, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Morano
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Laboratory of Sex-Gender Medicine, National Institute of Biostructures and Biosystems, Osilo, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Franconi
authors.affiliation: Department of Experimental Medicine, Sapienza University of Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lenzi
authors.affiliation: Department of Internal Medicine and Medical Specialties, Viale del Policlinico 155, 00144 Rome, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Basili
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012308:Risk Management; D012727:Sex Characteristics
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors
keywords: Diabetes; and prevention; antiplatelet therapy; cardiovascular disease; gender; sex; statins