From head to toe: Sex and gender differences in the treatment of ischemic cerebral disease. (July 2017)

• Record Type: Journal Article
• Authors: Falsetti, Lorenzo; Viticchi, Giovanna; Buratti, Laura; Balucani, Clotilde; Marra, Alberto M.; Silvestrini, Mauro
• Is Part Of: Pharmacological research. Volume 121(2017:Jul.)
• Page Start: 240
• Page End: 250
• Publication Date: 2017-07
• Subjects: ATRIA AnTicoagulation and Risk factors In Atrial fibrillation -- ALLHAT Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial -- AFFIRM Atrial Fibrillation Follow-up Investigation of Rhythm Management -- ACEI angiotensin-converting enzyme inhibitors -- ARB angiotensin receptor blockers -- ATLANTIS Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke -- AP acute phase -- BI Barthel index -- BP blood pressure -- ATC Antithrombotic Trialists' Collaboration -- CCB calcium channel blockers -- CARAF Canadian Registry of Atrial Fibrillation -- CASE Canadian Alteplase for Stroke Effectiveness Study -- DOACs Direct Oral Anticoagulants -- ED emergency department -- GAIN Glycine Antagonist in Neuroprotection for Patients with Acute Stroke Americas -- HR hazard ratio -- HF heart failure -- HT hypertension -- IAT intra-arterial thrombolysis -- ICH intracerebral haemorrhage -- IS ischemic stroke -- MI myocardial infarction -- IVT intra-venous thrombolysis -- JUPITER Justification for the Use of Statins in Preventionan Intervention Trial Evaluating Rosuvastatin -- LMWH low molecular weight heparin -- LOS length of stay -- MACE major cardiovascular events -- MH major haemorrhage -- M meta-analysis -- mRS modified Rankin Scale -- MOSES Morbidity and Mortality After StrokeEprosartan Compared With Nitrendipine for Secondary Prevention -- NIHSS National Institutes of Health Stroke Scale -- NINDS National Institute for Neurological Disorders and Stroke -- NVAF non-valvular atrial fibrillation -- OR odds ratio -- P perspective study -- PP primary prevention -- PROACT-2 Prolyse in Acute Cerebral Thromboembolism II -- PROGRESS Perindopril pROtection aGainst REcurrent Stroke Study -- RR rate ratio -- r-tPA recombinant tissue-type plasminogen activator -- R retrospective study -- RCT randomized controlled trial -- SR systematic review -- SE systemic embolism -- SP secondary prevention -- SIS-16 Stroke Impact Scale-16 score -- SITS-ISTR Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Register -- SITS-MOST Stroke International Stroke Thrombolysis Monitoring Study -- ECASSII Second European-Australasian Acute Stroke Study -- SPAF Stroke Prevention in Atrial Fibrillation -- SPORTIF Stroke Prevention Using Oral Thrombin Inhibitor in Atrial Fibrillation -- TZD thiazide diuretics -- TTR time in therapeutic range -- WHS Women's health study; Acute stroke -- Systemic thrombolysis -- Anti-platelet drugs -- Risk stratification -- Anti-hypertensive drugs -- Gender differences; Pharmacology -- Periodicals; Pharmacology -- Periodicals; Research -- Periodicals; Médicaments -- Recherche -- Périodiques; Pharmacologie -- Périodiques; 615.105
• DOI: 10.1016/j.phrs.2017.05.006
• Languages: English
• ISSNs: 1043-6618

Abstract

Graphical abstract: Abstract: Stroke is a major cause of mortality and morbidity, particularly in the older ages. Women have a longer life expectancy and are more likely to experience stroke than men. Interestingly, the increased risk of ischemic stroke in women seems to be independent from age or classical cardiovascular risk factors. Notwithstanding the fact that stroke outcomes and survival are usually poorer in women, current evidence suggests that thrombolysis, antiplatelet and anticoagulant therapies are more beneficial in women than in men. A possible explanation of this paradox might be that females are often undertreated and they have fewer chances to be submitted to an effective and timely treatment for stroke than the male counterpart. The first step in the attempt to solve this obvious discrimination is surely to emphasize any reasons for differences in the therapeutic approach in relation to gender and then to denounce the lack of a sustainable motivation for them. In this article, we aimed to review the existing literature about gender-related differences on efficacy, administration and side effects of the most common drugs used for the treatment of ischemic stroke. The most striking result was the evidence that the therapeutic approach for stroke is often different according to patients' gender with a clear detrimental prognostic effect for women. A major effort is necessary to overcome this problem in order to ensure equal right to treatment without any sexual discrimination.