ESC calls for sex-specific drug dosages of cardiovascular medication


Sex-specific cardiovascular drug dosages are needed to reduce adverse reactions in women, according to a position paper from the European Society of Cardiology (ESC). The paper, published in the European Heart Journal – Cardiovascular Pharmacotherapy, outlines the differences between women and men with respect to cardiovascular medications and gives recommendations on how to improve treatment in women.

An ESC press release reports that the key differences between women and men, with respect to cardiovascular diseases and drugs, are that:

  • Women are at greater risk of cardiovascular disease than men because they live longer
  • Cardiovascular drug recommendations are based on clinical trials in middle-aged men
  • Adverse drug reactions are more severe and more common in women than men
  • Women less often receive preventive treatments and are treated less aggressively than men
  • Women and men absorb, distribute, metabolise, and excrete drugs differently.

Furthermore, according to the press release, women have a 1.5 to 1.7-fold greater incidence of adverse reactions to cardiovascular drugs and these reactions tend to be more severe than in men— more often needing hospital admission. For example, women have a higher risk of drug-induced torsades de pointes and severe bleeding. Statin-induced myopathy is more common in older women with low body weight.

Also, there are sex-related differences in the pharmacokinetics of some widely used cardiovascular drugs. For example, the bioavailability and plasma levels of aspirin are higher in women than men, possibly due to lower activity of the enzyme aspirin esterase, and greater distribution and lower clearance of aspirin. These differences vanish with oral contraceptives and during pregnancy.

Lead author of the position paper, Juan Tamargo (Cardiovascular Pharmacology Research Group, Universidad Complutense, Madrid, Spain) says: “Cardiovascular drug recommendations are based on clinical trials in middle-aged men. Women have more adverse reactions from current dosages and may stop taking preventive medication, leaving them unprotected despite their higher risk.” He adds that women have more adverse reactions “because for many drugs, the same dose is recommended for everyone irrespective of body weight,” nothing that “this can lead to higher plasma levels and overdoses in women”.

Therefore, the paper has the following recommendations:

  • Develop and implement sex-specific guidelines for cardiovascular drugs
  • Include sex-specific dosages on cardiovascular drug labels
  • Enrol women in clinical trials of cardiovascular drugs
  • Educate doctors about sex differences in the pharmacokinetics and pharmacodynamics of cardiovascular drugs.

Tamargo concludes: “The most effective way to minimise adverse drug reactions in women is to develop and implement sex-specific guidelines for cardiovascular drugs.”




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