The Effect of SEX/Gender on Cardiovascular Pharmacology

Abstract: Cardiovascular diseases differ between men and women as do outcomes after therapeutic interventions. Management of these
diseases, however, is generally guided by evidence from trials conducted predominantly in men, with few studies focused on women
alone. Our goal is to review the sex/gender differences in cardiovascular therapies, which show many areas of uncertainty regarding
women due to their small enrolment in clinical trials; thus, in some cases, firm conclusions about efficacy in women are difficult to obtain.
Nevertheless, female gender appears to suffer from more adverse drug effects (ADE) than the male gender. For example, women are
significantly more likely to experience drug-induced QT-prolongation and torsade de pointes arrhythmia and many other types of ADE.
The major sex-specific differences present in pharmacokinetics, especially for the major drug metabolizing enzymes, the cytochromes
P450 family, but also for phase II reactions such as glucuronidation, are discussed. Pharmacodynamic mechanisms underlying sex/gender
differences are not clearly elucidated yet; however, this highlights the need for more studies focusing on women in order to optimize
sex/gender-specific therapy and, therefore, improve clinical outcomes in women with cardiovascular diseases.