Madrid, Spain—Because they have more adverse reactions from cardiovascular drugs, women are more likely to discontinue their medications. The solution, according to a position paper from the European Society of Cardiology, is to prescribe sex-specific cardiovascular drug dosages for the medications.
The article in the European Heart Journal – Cardiovascular Pharmacotherapy points out that women and men differ in body composition and physiology—i.e., hormonal influences during the menstrual cycle, menopause, and pregnancy—and they also vary in pharmacokinetics such as absorption, distribution, metabolism, and excretion, as well as in pharmacodynamics.
Yet women tend to be treated less often with evidence-based drug therapy, to have more adverse drug reactions, and to be underrepresented in clinical trials, according to the authors, led by Universidad Complutense, Madrid, researchers.
As a result, they add, current guidelines for prevention, diagnosis, and medical treatment for cardiovascular diseases are based on trials conducted predominantly in middle-aged men. The review pinpoints gender differences in the pharmacokinetics and pharmacodynamics of cardiovascular drugs and provides recommendations on how to mitigate those.
“Cardiovascular diseases kill a greater proportion of women than men in Europe, and they kill twice as many women as all cancers combined,” pointed out lead author Juan Tamargo, MD, PhD, director of the Cardiovascular Pharmacology Research Group at the Universidad Complutense.
“Cardiovascular drug recommendations are based on clinical trials in middle-aged men,” Tamargo added. “Women have more adverse reactions from current dosages and may stop taking preventive medication, leaving them unprotected despite their higher risk.”
The position paper explains that women are at greater risk of cardiovascular disease than men, partly because they live longer. Furthermore, women less often receive preventive treatments and are treated less aggressively than men.
Possibly because women and men absorb, distribute, metabolize, and excrete drugs differently, the review notes, women have a 1.5- to 1.7-fold greater incidence of adverse drug reactions (ADRs) to cardiovascular medications, and those ADRs tend to be more severe than in men, more often needing hospital admission.
The authors offer as examples two conditions—drug-induced torsades de pointes, for which women have higher risk, and statin-induced myopathy, which is more common in older women with low body weight.
“Women have more adverse reactions because for many drugs the same dose is recommended for everyone irrespective of body weight,” Tamargo said. “This can lead to higher plasma levels and overdoses in women.”
The guidelines recommend sex-specific guidelines for cardiovascular drugs, sex- specific dosages on labels, higher enrollment of women in trials of cardiovascular drugs and more education about sex differences in the pharmacokinetics and pharmacodynamics of cardiovascular drugs.
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