Gender differences in the effects of cardiovascular drugs.
Although sex-specific differences in cardiovascular medicine are well known, the exact influences of sex on the effect of cardiovascular drugs remain unclear. Women and men differ in body composition and physiology (hormonal influences during the menstrual cycle, menopause, and pregnancy) and they present differences in drug pharmacokinetics (absorption, distribution, metabolism, and excretion) and pharmacodynamics, so that is not rare that they may respond differently to cardiovascular drugs. Furthermore, women are also less often treated with evidence-based drugs thereby preventing optimization of therapeutics for women of all ages, experience more relevant adverse drug reactions than men, and remain underrepresented in most clinical trials. Thus, current guidelines for prevention, diagnosis, and medical treatment for cardiovascular diseases are based on trials conducted predominantly in middle-aged men. A better understanding of these sex-related differences is fundamental to improve the safety and efficacy of cardiovascular drugs and for developing proper individualized cardiovascular therapeutic strategies both in men and women. This review briefly summarizes gender differences in the pharmacokinetics and pharmacodynamics of cardiovascular drugs and provides recommendations to close the gaps in our understanding of sex-specific differences in drug efficacy and safety.
Department of Pharmacology, School of Medicine, Universidad Complutense, 28040 Madrid, Spain.|CIBERCV, Madrid, Spain.
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Tamargo
Cardiology Clinical Academic Group, St George's University Hospitals, NHS Foundation Trust, London SW17 0QT, Great Britain.|IRCCS San Raffaele Hospital, Department of Medical Sciences, Via Della Pisana 235, 00163 Rome, Italy.
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Rosano
Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork, Ireland.
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Walther
CIBERCV, Madrid, Spain.|Departamento de Farmacología, Facultad de Farmacia, Universidad de Granada, Granada 18071, Spain.
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Duarte
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Niessner
Cardiovascular Sciences Research Centre at St George's, University of London, Cranmer Terrace, London SW17 0RE, Great Britain.
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Kaski
University Hospital of Ferrara, U.O. Cardiologia, Post Degree School in Cardiology, Heart Failure and Cardiovascular Prevention Unit, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy.
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Ceconi
Department of Medicine and Cardiology, Academic Teaching Hospital and VIVIT Institute Carinagasse 47, 6800 Feldkirch, Austria.
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Drexel
Division of Cardiology, Department of Medicine, Copenhagen University Hospital (Holbaek Hospital), Holbaek, Denmark.|Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark.
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Kjeldsen
Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital , 171 76 Stockholm, Sweden.
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Savarese
Institute of Health Science and Technology, Aalborg University, Niels Jernes Vej 12, A5-208, 9220 Aalborg, Denmark.
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Torp-Pedersen
Department of Cardiology B, Oslo University Hospital and Institute of Clinical Sciences, University of Oslo, Kirkeveien 166, N - 0407 Oslo, Norway.
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Atar
Cardiovascular Clinical Research Institute, Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Lewis
Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Kirkeveien 166, N - 0407 Oslo, Norway.
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Agewall
D002317:Cardiovascular Agents / Q000494:pharmacology*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology; D014943:Global Health; D006801:Humans; D009017:Morbidity / Q000639:trends; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends
D002317:Cardiovascular Agents
Cardiovascular drugs; Gender; Pharmacodynamics; Pharmacokinetics; Sex