Aspects of pharmacology and therapy in female sex/gender
² Specialista Cardiologo, Presidente ARCA Molise, Italy
³ Responsabile settore educazionale Fondazione per il tuo Cuore – ANMCO
⁴ Day Hospital Cardiologia, Dipart. Specialita Medico-Chirurgiche, Scienze Radiologiche e Sanita Pubblica, Universita – ASST Spedali Civili di Brescia, Italy
Abstract
The present paper explores the impact of sex and gender differences on pharmacology and cardiovascular therapy, highlighting the necessity of personalized medicine. Historically, clinical research and drug development have relied on universal models, often based on male populations, leading to the underestimation of fundamental differences in drug response between women and men. The present document details how physiological variables – such as body composition, hepatic metabolism, and renal clearance – differ significantly between sexes and influence pharmacokinetics and pharmacodynamics. Women generally have higher body fat percentages, altered enzyme activity (notably in the cytochrome P450 family), and lower glomerular filtration rates, resulting in distinct drug absorption, distribution, metabolism, and elimination profiles. These differences have direct clinical implications, especially in cardiovascular therapy. For example, women metabolize ACE inhibitors and angiotensin receptor blockers differently and, needing lower dosages, they more frequently experience adverse effects such as persistent cough and hyponatremia. Beta-blockers tend to produce higher plasma concentrations in women, increasing the risk of bradycardia and fatigue. Platelet reactivity is also greater in women, which may reduce the protective efficacy of aspirin against myocardial infarction while maintaining benefits for stroke prevention. The chapter underscores the importance of adjusting therapeutic strategies and dosages based on sex-specific pharmacological profiles to optimize efficacy and minimize toxicity. It advocates for further research and the development of evidence-based recommendations tailored to female patients, aiming to advance personalized cardiovascular care.
Key words: Women; Sex and Gender Differences; Drug Metabolism; Adverse Drug Reactions; Pharmacology.
