Gender differences in cardiovascular prophylaxis: Focus on antiplatelet treatment

Abstract

Cardiovascular disease (CVD) represents the leading cause of death worldwide, and equally affects both sexes although women develop disease at an older age than men. A number of clinical evidence has identified the female sex as an independent factor for poor prognosis, with the rate of mortality and disability following an acute cardiovascular (CV) event being higher in women than men. It has been argued that the different level of platelet reactivity between sexes may account for a different responsiveness to anti-platelet therapy, with consequent important implications on clinical outcomes. However, conclusive evidence supporting the concept of a gender-dependent effectiveness of platelet inhibitors are lacking. On the contrary, sex-related dissimilarities have been evidenced in cardiovascular patients in terms of age of presentation, comorbidities such as obesity, diabetes and renal disease, and a different pharmacological approach to and effectiveness in controlling classical cardiovascular risk factors such as hypertension, glucose profile and lipid dysmetabolism. All these factors could place women at an increased level of cardiovascular risk compared to men, and may concur to an enhanced pro-thrombogenic profile. The purpose of this manuscript is to provide an overview of gender-related differences in cardiovascular treatment, in order to highlight the need to improve the pharmacological prophylaxis adopted in women through a more accurate evaluation of the overall cardiovascular risk profile with consequent establishment of a more effective and targeted anti-thrombotic strategy which is not limited to the use of antiplatelet agents.

Sex Differences in Physiological Stress Induced by a Long-Lasting Adventure Race: A Prospective Observational Analytical Study

“…However, the difference did not exacerbate after the race (platelets -Cohen's d before: 0.62 vs. Cohen's d after: 0.58; leukocyte -Cohen's d before: 0.29 vs. Cohen's d after: 0.41). The difference of platelet activity and immunological system between sexes is in accordance with the literature in non-athlete subjects [27,28]. It is well documented that pre-menopausal women show increased platelet activity compared to men, including platelet-to-platelet aggregation, interaction with leukocytes to form heterotypic aggregates and adhesiveness to fibrinogen [28].…”

“…The difference of platelet activity and immunological system between sexes is in accordance with the literature in non-athlete subjects [27,28]. It is well documented that pre-menopausal women show increased platelet activity compared to men, including platelet-to-platelet aggregation, interaction with leukocytes to form heterotypic aggregates and adhesiveness to fibrinogen [28]. In addition, prior to menopause differences between males and females regarding the immunological system had been reported in humans [27] and animals [29].…”

Persistent sex disparities in clinical outcomes with percutaneous coronary intervention: Insights from 6.6 million PCI procedures in the United States

“…Secondly, a greater risk for bleeding appears, to some extent, inherent in female patients, as reflected in its use on bleeding risk scores [27]. This may relate to sex differences in responsiveness to antiplatelet and other therapies [28]. Increase in radial access mitigates bleeding risks in women as for men [29, 30] but higher levels of cross-over to the femoral approach in women has been noted in studies, which may therefore contribute to higher periprocedural risk [31].…”

Sex differences in spontaneous reports on adverse drug events for common antihypertensive drugs

“…National data from the USA show that hypertension is more frequent among women [36], and there are studies reporting different choices of antihypertensive drug classes in the treatment of women and men, with men more often receiving ACE-I and women more likely to be on diuretics [37, 38]. Gender disparities have been reported in terms of BP treatment, with women less likely to receive a beta blocker, a calcium antagonist, or an ACE-I, than a diuretic [39].…”