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Sex Differences in Secondary Prevention Pharmacotherapy for Acute Coronary Syndromes
Andrew J Sullivan1,2, Margaret Siu1, Krishnaraj Rathod1,2
11Barts and the London Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom;
None:
Global data demonstrate that women have worse outcomes following acute coronary syndromes (ACS) compared to men. Routine follow-up care for ACS involves optimal medical therapy (OMT) to reduce the risk of future adverse cardiovascular outcomes; however, women are both less likely to receive OMT and underrepresented in cardiovascular clinical trials; thus, a sex bias exists in the evidence for many OMT drugs. In this review we examine sex-specific data for OMT, exploring sex differences in the pharmacology and clinical efficacy of these drugs. We outline various sex differences in the pharmacodynamics and pharmacokinetics of OMT drugs, which do not appear to result in convincing differences in efficacy. However, women are at increased risk of drug-related side effects, which has important implications for adherence and discontinuation. Sex-specific guidance is needed for current OMT medications to address differences in prescribing and side effect profiles. Understanding the sex-specific pharmacology of OMT is key to providing more personalized care.
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