Sex-specific doses of cardiovascular drugs are needed to reduce adverse events in women, according to a position paper published earlier this year in the European Heart Journal. [1]

In this paper, the authors state that: “Women and men differ in body composition and physiology […] and they present differences in drug pharmacokinetics […] and pharmacodynamics, so that it is not rare that they respond differently to cardiovascular drugs.” [1]

Furthermore, they highlight that current guidelines are based on evidence gained from trials that were “conducted predominantly in middle-aged men.” [1]

In a press release issued by the European Society of Cardiology, lead study author Dr Juan Tamargo says: “Cardiovascular disease kills a greater proportion of women than men in Europe, and they kill twice as many women as all cancers combined,” adding that: “Women have more adverse reactions from current dosages and may stop taking preventative medication, leaving them unprotected despite their greater risk.” [2]

Of course, this is not a new problem. Dr Martha Gulati, Professor of Medicine and Chief of the Division of Cardiology at The University of Arizona-Phoenix, US, wrote in her best-selling book ‘Saving Women’s Hearts: How You Can Prevent and Reverse Heart Disease with Natural and Conventional Strategies’ that: “The medicine we were practicing took for granted that women are the same as men – that they would present in the same way and respond to medications in the same way, that their disease patterns for heart disease would be identical to men, and that the tests used to diagnose heart disease would work equally as well in women as men, even if they were not tested or validated in women. But these were assumptions, not facts.” [3]

“We really are just beginning to understand what is going on in women’s hearts, and change goes beyond the measures that we take to improve our individual heart health,” she writes. “What we need and deserve is further research in the area of heart disease prevention in women.” [3]

However, things are improving. In the US, the FDA Office of Women’s Health has funded 69 studies since 1994 that focus on women and heart disease, [5] and the British Heart Foundation is funding a range of studies that look at issues specific to women in cardiology, including understanding conditions like pre-eclampsia, the role of the BCAR1 gene in CVD and stroke, understanding the role of hormones in pulmonary hypertension and obtaining a greater understanding of gestational diabetes. [6]

However, as Dr Tamargo states: “The most effective way to minimise adverse drug reactions in women is to develop and implement sex-specific guidelines for cardiovascular drugs.” [2]

References

1. Tamargo J, Rosano G, Walther T, et al., Gender differences in the effects of cardiovascular drugs. Eur Heart J Cardiovasc Pharmacother 2017: 3(3): 163-182.
2. https://www.escardio.org/The-ESC/Press-Office/Press-releases/sex-specific-cardiovascular-drug-dosages-needed-to-reduce-adverse-reactions-in-women
3. Saving Women’s Hearts: How You Can Prevent and Reverse Heart Disease with Natural and Conventional Strategies. Martha Gulati, MD, MS, FACC, FAFA, Sherry Torkos, BSc, PHM. Wiley Publishers, 2011.
4. https://www.bhf.org.uk/heart-matters-magazine/medical/women/misdiagnosis-of-heart-attacks-in-women
5. https://www.fda.gov/scienceresearch/specialtopics/womenshealthresearch/ucm134670.htm
6. https://www.fda.gov/scienceresearch/specialtopics/womenshealthresearch/ucm134670.htm