[Gender differences in vascular medicine]

In vascular medicine only a few studies concerning gender differences in vascular diseases, course of the disease and therapy exist. Risk factors are allocated differently between men and women with different influences on cardiovascular diseases. Diabetic women do have a particular high risk. The proportion of women smokers with a risk for aggravation of the other risk factors is increased. In young female smokers the hypoplastic aortoiliac syndrome is a special course of peripheral arterial disease associated with a bad prognosis. The benefit of hormone replacement therapy in vascular diseases of postmenopausal women has not yet been demonstrated. On the other hand testosterone seems to have a favourable effect on vascular diameter and endothelium of coronaries. Women with peripheral arterial disease represent high risk patients with a particular risk for cardiovascular letality. Periprocedural complications of the analysed operations or interventions are found more frequent in women. Furthermore the disease is in an advanced stage when treated. Especially men with asymptomatic high grade carotid stenosis benefit more from an operation than women because of the higher risk for ischemic stroke. Unfortunately the benefit of the operation in women is neutralized by the higher rate of periprocedural complications. Some studies demonstrate the gender bias in treatment: women seldom receive revascularisation and guideline therapy as frequently as men. The same is true with thromboembolic prophylaxis concerning in hospital patients. In pharmacotherapy women have in result of metabolism more side effects. Additionally women are underrepresented in drug admission studies compared to their percentage of population and gender prevalence of diseases. Further studies concerning gender differences in vascular medicine are definitely needed.