If premenopausal women require such medications, a detailed discussion with the patient and a concrete plan for contraception is strongly recommended. Use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers are not generally recommended for women of childbearing potential due to their potential teratogenic effects.Gender differences in therapeutic effects on stress-induced angina, overall survival, hypertension, and heart failure have been observed in various studies however, a meta-analysis observed similar survival benefit in heart failure and after myocardial infarction among men and women. Oral contraceptives may also alter effects of metoprolol. Thus, greater reductions in exercise-related heart rates and systolic blood pressure may be observed in women compared to men. Women have been observed to have higher plasma levels of metoprolol and propranolol due to slower clearance and lower volume of distribution.The authors of this European Society of Cardiology (ESC) statement hypothesize this may relate to excess dose however, sex-based differences in digoxin pharmacokinetics were not observed. Digoxin was associated with increased risk of death and worsening heart failure in women compared to men in the DIG study.For secondary prevention, aspirin appears to have similar benefits among men and women. Low-dose aspirin does appear to lower stroke risk. Similar reductions in platelet reactivity have been observed in men and women however, aspirin in primary prevention does not appear to lower the risk for myocardial infarction in women. Aspirin has been used for both primary and secondary prevention of cardiovascular events.Despite these known differences in pharmacokinetics, many drugs are not well studied for their potential gender-related differences. Gender-related differences in renal excretion are often normalized when adjustment for body weight is made. Hepatic drug clearance is lower in women, which can affect several types of cardiovascular medications. Exogenous sex hormones and increase in serum binding globulin levels can modify effects of drugs such as warfarin, which binds to plasma proteins. Women typically have higher body fat, which translates into faster onset and greater duration of action of lipophilic drugs. Gender-related differences exist in the pharmacokinetics of drugs due to gender differences in body composition, plasma protein binding, metabolizing enzymes, and difference in excretion characteristics.

Women are under-represented in clinical trials women comprise approximately one third of study populations for cardiovascular drug trials.The following are 10 points to remember about gender differences in the effect of cardiovascular drugs:

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