July 4, 2005European Heart Journal
Female-specific aspects in the pharmacotherapy of chronic cardiovascular diseases
Key result
Pharmacotherapy of chronic cardiovascular diseases exhibits gender-specific differences in pharmacokinetics and pharmacodynamics, yet women remain under-represented in clinical studies.
Why the study?
Differences in pharmacokinetics, pharmacodynamics, physiology, and hormones cause women and men to respond differently to cardiovascular drugs, but women remain under-represented in studies.
Are there gender-specific differences in the pharmacokinetics, pharmacodynamics, and benefits of pharmacotherapy for chronic cardiovascular diseases?
Key Points
- Examine pharmacodynamic and pharmacokinetic sex differences and evaluate therapeutic evidence for treating chronic cardiovascular diseases in women.
- Narrative review synthesizing literature on sex-specific physiological, hormonal, and drug-response mechanisms.
- Analysis of drug plasma level fluctuations across the menstrual cycle, pregnancy, and menopause.
- Hormonal fluctuations and changes in total body water alter cardiovascular drug plasma levels, posing heightened risks for agents with narrow therapeutic margins.
- Women remain consistently underrepresented in cardiovascular clinical trials, resulting in an ongoing lack of sex-specific therapeutic outcome analyses.
Structured PICO
Are there gender-specific differences in the pharmacokinetics, pharmacodynamics, and benefits of pharmacotherapy for chronic cardiovascular diseases?
P
Population
Women with chronic cardiovascular diseases
I
Intervention
Pharmacotherapy for chronic cardiovascular diseases
O
Outcome
Pharmacodynamic gender-relevant differences and benefits of therapy
This review highlights the critical need for gender-specific analyses in cardiovascular pharmacotherapy, given the physiological and hormonal differences that affect drug response in women.
Limitations
- Women are under-represented in most studies
- Few gender-specific analyses have been conducted
Ask about this paper
Answers are grounded in this paper and cite their sources.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Cardiovascular drug recommendations are based on clinical trials in middle-aged men. Women have more adverse reactions from current dosages and may stop taking preventive medication, leaving them unprotected despite their higher risk.”
BTBernadet T. SantemaPhysician-researcher, University Medical Center Groningen
“In men, the lowest hazards of death or hospitalization for heart failure occurred at 100% of the recommended dose of ACE inhibitors or ARBs and beta-blockers, but women showed about 30% lower risk at only 50% of the recommended doses, with no further decrease in risk at higher dose levels.”
Implication
Sex and hormonal status may influence cardiovascular drug responses; leaves open the need for dedicated trials before changing practice.
Abstract
Differences in pharmacokinetics, pharmacodynamics, and physiology contribute to the phenomenon that women and men frequently respond differently to cardiovascular drugs. Hormonal influences, in addition, can play an important role: for example, the menstrual cycle, menopause, and pregnancy--as a result of fluctuations in concentrations of sexual steroids, and of changes in total body water--can be associated with gender-specific differences in the plasma levels of cardiovascular drugs. Clinical relevance accordingly results, especially for substances with a narrow therapeutic margin. This review treats the most important pharmacodynamic gender-relevant differences in this context, and surveys available evidence on the benefits of therapy of chronic cardiovascular diseases in women. On the whole, the study situation for women is appreciably less favourable than for men: owing to the fact that women are under-represented in most studies, and that few gender-specific analyses have been conducted.
Discussion
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Cite This Study
Jochmann et al. (2005) conducted a review in Chronic cardiovascular diseases. Pharmacotherapy was evaluated. Pharmacotherapy of chronic cardiovascular diseases exhibits gender-specific differences in pharmacokinetics and pharmacodynamics, yet women remain under-represented in clinical studies.