You know. Men and women can respond differently to the effects of the same therapy. But also the hormonal status in the woman, therefore the presence or absence of estrogen of the fertile life compared to the drastic drop in hormones of the menopause, could have a significant weight in the action of drugs. An Italian scientific analysis now adds a piece to the mosaic of evidence for a “gender therapy” that also considers the age of the woman. In a sort of reverse “serendipity”, or rather a return to the origins for a drug of the class of phosphodiesterase type 5 inhibitors (PDE5i), in this case tadalafil, widely studied and used in men) it has been seen that the actions of treatment are not only different between males and females, but also in women based on hormonal status. This therapy, born as a possible treatment for cardiovascular diseases but then used for the treatment of erectile dysfunction, was in fact the focus of an independent study by the research group of the University of Rome “Sapienza”, coordinated by Andrea Isidori. The research, which appeared on Science Translational Medicine, demonstrates that this approach represents a kind of demonstration of the gender effects of treatments: it may be useful for promoting the improvement of cardiac contraction in men with type 2 diabetes, but it would not do the same in women. Or rather, not in premenopausal women. The possible effect on the fairer sex would be linked to age, because it is probably mediated by the presence or absence of estrogen hormones. In short: for those suffering from diabetes, it is necessary to “phenotype” or study a tailor-made treatment, which does not only pay attention to gender, but also to the age of the woman.
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The importance of specific therapies
Also because the study evaluated all the possible “objectives” of PDE5, from cardiac magnetic resonance imaging, to renal vascular imaging, to the immune profile, up to the molecular characteristics. And it has shown that the therapy, in addition to having a gender effect with a clear preference for males, can help menopausal women (but not the youngest) at risk for kidney disease. “Our study finally identifies the phenotypes of diabetic patients who can benefit from PDE5i treatment: men suffering from diabetes-related microvascular complications (erectile dysfunction, cardiomyopathy, kidney disease) and menopausal women at risk for kidney disease – they explain Riccardo Pofi (currently researcher at the University of Oxford) ed Elisa Giannetta, first authors of the study in question “. “We are sure that the lack of estrogen is the reason why women have not been able to achieve the heart improvement seen in men – he adds. Isidorus. Pharmaceutical companies should keep in mind that pre-menopausal and post-menopausal women may respond differently to drugs, and therefore should be adequately represented in clinical trials. “In short: in a logic of precision medicine, it is necessary respect not only the gender but also the age of the patients. As Pofi points out, “the prescription of a drug therapy must take into account sex, menopause, the stage of the disease, concomitant drug therapies and, why not, the cost of the therapy “.
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More and more tailor-made treatments and prevention
Research once again confirms the need for cardiovascular therapy “tailored to women”, designed for the different stages of life. If it is true that during the fertile period of their life women are really at a lower risk of developing cardiovascular diseases than men, obviously without prejudice to any congenital or metabolic pathologies, it is undeniable that this protection disappears after menopause, when female hormones estrogen fails. Also in prevention, after all, it is necessary to focus on “differences”. For example, it is enough for a woman to smoke a third of a man’s cigarettes to have the same impact on the heart and blood vessels. Again: there is a higher incidence of obesity and metabolic syndrome in women and this figure increases the risk of coronary heart disease in women by 50 percent. Furthermore, it must be remembered that more attention is needed when there are “spies” such as polycystic ovary, or problems related to pregnancy, such as gestational diabetes, preterm births, polyabortivity, chemo and radiotherapy treatments for breast cancer, or even inflammatory, autoimmune and endocrinological diseases. Finally, the psyche plays an important role. Research suggests that women in general, and menopausal women in particular, are more likely than men to develop depressive or anxiety disorders.
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