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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;

Annual Review of Pharmacology and Toxicology
|July 21, 2026
PubMed

Insights

Women experience worse outcomes after acute coronary syndromes (ACS) and are less likely to receive optimal medical therapy (OMT). This review highlights sex differences in OMT drug efficacy and side effects, emphasizing the need for personalized cardiovascular care.

Area of Science:

  • Cardiology
  • Pharmacology
  • Sex and Gender in Medicine

Background:

  • Women face poorer outcomes after acute coronary syndromes (ACS) compared to men.
  • Optimal medical therapy (OMT) is crucial for ACS management but evidence is sex-biased due to underrepresentation of women in clinical trials.
  • Existing OMT guidelines may not fully address sex-specific needs.

Purpose of the Study:

  • To review sex-specific data on optimal medical therapy (OMT) for acute coronary syndromes (ACS).
  • To explore sex differences in the pharmacology, clinical efficacy, and side effect profiles of OMT drugs.
  • To advocate for sex-specific guidance in ACS management.

Main Methods:

  • Comprehensive literature review of sex-specific data on OMT in ACS.
  • Analysis of pharmacological data (pharmacodynamics and pharmacokinetics) for OMT drugs in women versus men.
  • Examination of clinical trial data and real-world evidence regarding efficacy and adverse events.

Main Results:

  • Pharmacodynamic and pharmacokinetic differences in OMT drugs between sexes do not significantly impact overall efficacy.
  • Women exhibit a higher risk of drug-related side effects from OMT, potentially affecting adherence and treatment discontinuation.
  • A notable sex bias persists in the evidence base for cardiovascular medications used in ACS.

Conclusions:

  • Sex-specific pharmacology of OMT drugs is understood, but clinical application requires refinement.
  • Addressing increased side effect risk in women is critical for improving OMT adherence and long-term outcomes.
  • Development of sex-specific guidance for OMT is essential for personalized and effective ACS care.

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