Zusammenfassung
Die Gendermedizin will erklären, warum Erkrankungen bei den beiden Geschlechtern unterschiedlich verlaufen. Sie berücksichtigt Unterschiede zwischen Mann und Frau, die die traditionelle Medizin oft vernachlässigt. Geschlechterunterschiede finden sich auch bei Herz-Kreislauf-Erkrankungen. So haben Risikofaktoren für Herz-Kreislauf-Erkrankungen je nach Geschlecht eine unterschiedliche Bedeutung. Diabeteserkrankungen etwa fördern das Auftreten einer koronaren Herzkrankheit (KHK) bei Frauen stärker als bei Männern. Herzinfarkte betreffen Frauen 10 Jahre später als Männer. Bei jungen Frauen werden sie oft zu spät behandelt, womöglich weil sie als „Männerkrankheit“ gelten. Die Zahl der akuten Koronarsyndrome nimmt vor allem bei jüngeren Frauen signifikant zu. Überwiegend bei Frauen treten unter anderem das Tako-Tsubo-Syndrom, Mikrozirkulationsstörungen und die spontane Koronardissektion auf. Die Arzneimitteltherapie der KHK ist bei Frauen und Männern im Prinzip gleich. Zu beachten sind aber Unterschiede in der Pharmakokinetik wichtiger Arzneimittel. Eine Koronardilatation hat bei Frauen und Männern vergleichbare Effekte, bei Frauen treten aber mehr Komplikation auf. Eine Herzinsuffizienz (HI) mit eingeschränkter linksventrikulärer systolischer Funktion betrifft in der westlichen Welt mehr Männer als Frauen. Bei der HI mit erhaltener linksventrikulärer Auswurffraktion verhält es sich umgekehrt. Hypertrophe und dilatative Kardiomyopathien sind bei Männern häufiger. Zahlreiche HI-Medikamente wirken bei Männern und Frauen unterschiedlich. Pharmakokinetik und -dynamik bei Frauen werden in der Testung von Wirkstoffen zu wenig berücksichtigt. Das Bewusstsein für die zu beachtenden Unterschiede wächst allerdings.
Abstract
Gender medicine is concerned with the question of why diseases are expressed differently in the genders. It takes differences between men and women into account, which are often neglected by traditional medicine. Sex differences can also be found in cardiovascular diseases; therefore, risk factors for cardiovascular diseases have a different significance depending on the sex. Diabetic diseases tend to promote the occurrence of coronary heart disease (CHD) more strongly in women than in men. Myocardial infarctions affect women 10 years later than men and young women are often treated too late, possibly because myocardial infarction is consider to be a “male disease”. The number of cases of coronary syndrome is significantly increasing, particularly in young women. Some of the diseases which predominantly occur in women are takotsubo cardiomyopathy, microcirculation disorders and spontaneous coronary artery dissection. Pharmacological treatment of CHD is principally the same in men and women but attention must be paid to differences in the pharmacokinetics of important drugs. Coronary dilatation has comparable effects in both men and women but more complications occur in women. Cardiac failure with impaired left ventricular systolic function affects more men than women in the Western world but the opposite is true for cardiac failure with preserved left ventricular ejection fraction. Hypertrophic and dilatative cardiomyopathies are more frequent in men. Many of the drugs used to treat cardiac failure have different actions in men and women. Too little attention is paid to the pharmacokinetics and pharmacodynamics in women when testing active agents; however, awareness of the differences that need to be considered is growing.
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Ich danke Arne Kühne für die exzellente Bearbeitung der Literatur.
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Regitz-Zagrosek, V. Geschlecht und Herz-Kreislauf-Erkrankungen. Internist 58, 336–343 (2017). https://doi.org/10.1007/s00108-017-0214-3
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DOI: https://doi.org/10.1007/s00108-017-0214-3