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. 2024 May 16;26(Suppl 2):ii264-ii293.
doi: 10.1093/eurheartjsupp/suae034. eCollection 2024 Apr.

Italian Association of Hospital Cardiologists Position Paper 'Gender discrepancy: time to implement gender-based clinical management'

Fabiana Lucà  1 , Daniela Pavan  2 , Michele Massimo Gulizia  3 , Maria Teresa Manes  3 , Maurizio Giuseppe Abrignani  4 , Francesco Antonio Benedetto  1 , Irma Bisceglia  5 , Silvana Brigido  6 , Pasquale Caldarola  7 , Raimondo Calvanese  8 , Maria Laura Canale  9 , Giorgio Caretta  10 , Roberto Ceravolo  11 , Alaide Chieffo  12 , Cristina Chimenti  13 , Stefano Cornara  14 , Ada Cutolo  15 , Stefania Angela Di Fusco  16 , Irene Di Matteo  17 , Concetta Di Nora  18 , Francesco Fattirolli  19 , Silvia Favilli  20 , Giuseppina Maura Francese  3 , Sandro Gelsomino  20 , Giovanna Geraci  21 , Simona Giubilato  22 , Nadia Ingianni  23 , Annamaria Iorio  24 , Francesca Lanni  25 , Andrea Montalto  26 , Federico Nardi  27 , Alessandro Navazio  28 , Martina Nesti  29 , Iris Parrini  30 , Annarita Pilleri  31 , Andrea Pozzi  24 , Carmelo Massimiliano Rao  1 , Carmine Riccio  32 , Roberta Rossini  33 , Pietro Scicchitano  34 , Serafina Valente  35 , Giuseppe Zuccalà  36 , Domenico Gabrielli  37   38 , Massimo Grimaldi  39 , Furio Colivicchi  16 , Fabrizio Oliva  17
Affiliations

Italian Association of Hospital Cardiologists Position Paper 'Gender discrepancy: time to implement gender-based clinical management'

Fabiana Lucà et al. Eur Heart J Suppl. .

Abstract

It has been well assessed that women have been widely under-represented in cardiovascular clinical trials. Moreover, a significant discrepancy in pharmacological and interventional strategies has been reported. Therefore, poor outcomes and more significant mortality have been shown in many diseases. Pharmacokinetic and pharmacodynamic differences in drug metabolism have also been described so that effectiveness could be different according to sex. However, awareness about the gender gap remains too scarce. Consequently, gender-specific guidelines are lacking, and the need for a sex-specific approach has become more evident in the last few years. This paper aims to evaluate different therapeutic approaches to managing the most common women's diseases.

Keywords: Cardiovascular drugs; Cardiovascular therapy; Gender; Gender differences; Pharmacodynamics; Pharmacokinetics; Sex; Women.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
It has been shown that women are largely under-represented in randomized controlled trials (RCTs), leading to inadequate sex-specific analysis and misconceptions about cardiovascular risk in women. This under-representation has significant implications for understanding the effectiveness and safety of treatments in women with acute coronary syndrome (ACS) and other cardiovascular conditions. Optimal medical therapy (OMT) and invasive procedures (PCI/CABG) have been described. Studies have consistently shown that women with ACS are less likely to receive OMT and undergo invasive procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) compared to men. The severity of ACS in women may be underestimated due to atypical symptoms and lower rates of obstructive coronary artery disease (CAD) on angiography. Moreover, women often experience delays in the diagnosis and treatment of ACS, which can result in missed opportunities for initiating OMT and recommending invasive procedures. Women with ACS may exhibit higher levels of certain coagulation factors than men. This difference in coagulation factor levels may contribute to variations in the pathophysiology, presentation, and outcomes of ACS between genders. Here's why women might have higher levels of coagulation factors. Higher levels of coagulation factors in women with ACS may contribute to a prothrombotic state, increasing the risk of thrombotic events such as myocardial infarction and stroke. Understanding these gender-specific differences in the coagulation system is essential for tailoring treatment strategies and improving outcomes in women with CAD. Women are more likely to have conditions such as Ischemia with No Obstructive Coronary Arteries (INOCA) and Spontaneous Coronary Artery Dissection (SCAD). These conditions may present symptoms similar to obstructive CAD but may not be detected by traditional angiography. This can lead to underdiagnosis, delays in treatment, and potentially poorer outcomes if not appropriately managed. CAD, coronary artery disease; INOCA, no obstructive coronary arteries; SCAD, spontaneous coronary artery dissection; ACS, acute coronary syndrome; PCI: percutaneous coronary intervention; CABG: coronary artery bypass grafting.
Figure 2
Figure 2
The figure represents the prevalence of females in the ORION 9, -10, and -11 studies.
See this image and copyright information in PMC

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