Gender gap and differences in efficacy and safety in the treatment of patients with coronary heart disease

Susanne Unverzagt, Monika Nothacker, Thomas Frese

Keywords: gender differences, coronary heart disease, evidence-based medicine

Background:

Cardiovascular disease is the leading cause of death worldwide. Due to the high prevalence of the disease, the treatment of patients with chronic coronary heart disease (CHD) is of particular interest to prevent mycardial infarction, development of heart failure and to reduce mortality. In Germany, women die more often from myocardial infarction and are less often treated with revascularization, with these differences being mainly associated to older age and an unfavorable distribution of cardiovascular risk compared to men. The current guidelines recommend a variety of drug therapies addressing different targets (thrombosis aggregation inhibitors, lipid-lowering agents, beta-receptor blockers, inhibitors of the RAS-system, prophylaxis and symptomatic treatment of angina pectoris). The GP’s tasks include individual counselling of patients, monitoring symptoms and promoting adherence to prescribed medication.

Research questions:

The aim of the planned work is to investigate to what extent gender aspects were taken into account in the conduct of the individual studies and in the synthesis of evidence in systematic reviews for patients with CHD:
• Are the study populations comparable to the general population in terms of gender as well as age, cardiovascular risk factors, comorbidities and socioeconomic factors?
• Are there indications of gender-specific differences in efficacy and in the occurrence of adverse effects of drugs?

Method:

Systematic search in Medline (Ovid) and Cochrane for recent, high-quality systematic reviews on the efficacy of drug therapies recommended in current European guidelines, evaluation of the methodological quality, extraction of the number of men and women included, their age range and further characteristics, and comparison of the results on key endpoints as all-cause and cardiovascular mortality, myocardial infarction and safety.

Results:

Conclusions:

Points for discussion:

Are you aware of gender differences in the treatment of patients with CHD?

Which differences are most relevant in your practice (diagnosis, pharmacological or non-pharmacological treatment)?

#31