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[心血管疾病的性别特异性诊断与治疗]

[Sex-specific diagnostics and treatment of cardiovascular diseases].

作者信息

Stangl Verena, Brand Anna

机构信息

Klinik für Kardiologie, Angiologie und Intensivmedizin, Deutsches Herzzentrum der Charité (DHZC), Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland.

DZHK (Deutsches Zentrum für Herzkreislaufforschung), Partner site Berlin, Berlin, Deutschland.

出版信息

Herz. 2025 Apr;50(2):113-121. doi: 10.1007/s00059-025-05303-3. Epub 2025 Mar 21.

Abstract

There are relevant sex-specific differences for coronary heart disease, heart failure, takotsubo syndrome and atrial fibrillation. The underrepresentation of women in clinical studies and the fact that sex-specific aspects and analyses are still insufficiently taken into consideration in preclinical and clinical research raises questions on the transferability of research results to women and strongly contrasts with the generally agreed requirements of evidence-based medicine. Sex-specific aspects are not always adequately addressed even in guidelines. Less than half of 24 ESC guidelines from 2018-2023 contain a corresponding section. In more recent recommendations, such as the guidelines on hypertension from 2024, sex-specific considerations are discussed, also with regards to the "gaps of evidence". In this context, in addition to the demands for more prospective sex-specific studies and data on epidemiology, risk factors, pathophysiology and outcomes, the importance of providing evidence with respect to sex-specific optimal dosages, effects and undesired side effects of drugs are also the subjects of discussion.

摘要

冠心病、心力衰竭、应激性心肌病和心房颤动存在相关的性别差异。临床研究中女性代表性不足,以及临床前和临床研究仍未充分考虑性别特异性方面和分析,这引发了关于研究结果对女性的可转移性的问题,并且与循证医学的普遍公认要求形成强烈反差。即使在指南中,性别特异性方面也并非总是得到充分解决。2018年至2023年的24项欧洲心脏病学会(ESC)指南中,不到一半包含相应章节。在最近的建议中,如2024年的高血压指南,讨论了性别特异性考量,也涉及“证据缺口”。在此背景下,除了对更多前瞻性性别特异性研究以及流行病学、危险因素、病理生理学和结局数据的需求外,提供关于药物性别特异性最佳剂量、效果和不良副作用的证据的重要性也是讨论的主题。

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