Diagnosis and treatment of acute coronary syndromes up2date in men and women and their medical differences - Dr. Nabil DEEB
Gender-specific pharmaco therapy and acute coronary syndromes?
Acute coronary syndromes: the case of immediate treatment improved prognosis! .
Acute coronary syndromes are detected less frequently in women than in men .
If adequately treated, the prognosis is for them but better.
Thus, while a Finnish cohort study shows that the age-standardized annual incidence of angina pectoris (AP) in women with 1.89 / 100 persons in the population is slightly lower than in men (2.03). But women under 75 with a positive test AP had almost twice as high mortality as men (4.69 / 100 vs. 2.40 / 100.). Does diabetes mellitus to be the event rates are rising sharply in both sexes, in women but to a little more (9.9 / 100 vs. 9.3 / 100) .
Patients with acute myocardial infarction in comparison to men by an average of about eight to ten years older and have more cardiovascular risk factors .
The major risk factors include diabetes mellitus, hypertension, hyperlipidemia, heart failure and angina pectoris (AP) .
Other symptoms: -
There are, especially in younger women, a significant proportion of unrecognized myocardial infarction .
It was shown in some studies that were found in a cohort of women, the four years were observed in 9.3% of past myocardial infarction (MI) with Q waves on ECG. Of these, 46% not previously been diagnosed!
One reason could be that the past myocardial infarction (MI) - no symptoms in women "clearly" is. Thus, women with myocardial infarction (MI), frequent pain in the neck, jaw and back, associated with nausea and in some cases of typical angina pectoris (AP) - symptoms. With more than 40% of women with acute MI, however, there is no angina pectoris (AP) - symptoms before .
Diagnosis :-
The number of women with acute myocardial infarction who receive within two hours after symptom onset aid is lower than that of men. There is evidence in the literature that women are assigned to coronary angiography less often than men, which can be fatal. The mortality of women with a positive ischemia without coronary angiography after three years is 14.3% vs. 6% in men .
Note also that in women with chest pain, the prevalence of CHD is lower than in men. Inconspicuous coronary angiography findings can be found in suspected coronary artery disease only 8% in men, but to 41% in women. About 20% of women with documented myocardial ischemia have unremarkable coronary arteries. This so-called cardiac syndrome X show by demonstrating a positive stress test AP with normal epicardial coronary arteries and is strongly associated with psychological morbidity and severe symptomatology. It is here, of microvascular angina with impaired endothelial function .
ACS without ST elevation :-
In acute coronary syndrome (ACS) without ST elevation (either unstable angina or non-ST-segment elevation myocardial infarction, NSTEMI short) Women are more often an increase of BNP and CRP, the rare troponins and CK-MB .
When a positive marker evidence is available, an invasive strategy should be chosen in the absence of markers, a conservative strategy .
Overall, women in this situation but, despite more pronounced comorbidity, at least as good if not better prognosis than men - provided they are also treated equally well .
Gender-specific drug delivery :-
Studies provide increasing evidence of gender differences in the activity profile of drugs .
NUMEROUS STUDIES not only provide evidence that women and men may respond differently to drug therapies, but also that female gender appears to be a risk factor for adverse drug reactions is sometimes dangerous .
DIFFERENCES IN THE DISTRIBUTION PROCESSES :-
A not insignificant role can also gender differences in the distribution processes in the organism .
Women than men on average a lower Body weight, a higher body fat percentage, a smaller volume of blood plasma and increased organ perfusion .
If these differences in the dosage of drugs not taken into account, there is in women at increased risk of about severe drug reaction, especially when therapy with water-soluble drugs are distributed only to the body of water in the world, with women significantly less than in men .
Most drugs are in the blood plasma in greater or lesser extent reversibly bound to proteins. Apparently, a gender difference in the extent of plasma protein binding .
For instance the concentration of acid 1-glycoprotein in the blood plasma in women is lower than in men, so that to be expected with reduced protein binding of basic drugs must .
DIFFERENT ENZYME ACTIVITIES :-
Different effects of drugs in women and men can also complex differences in the activity of those enzymes are based, which break down drugs in the body .
The drug metabolism takes place mainly in the liver and often runs in two phases. Phase I reactions are referred to as functionalization. As part of these reactions are introduced mainly by oxidation and reduction processes of functional groups in the drug molecule or expose corresponding groups .
The Phase II conjugation reactions are caused by different transferases as described enzymes are catalyzed and endogenous molecules such as glucuronic acid or glutathione couple to the impurity molecule .
Overall, the chemical changes in the metabolism of fat-soluble drugs readily water-soluble metabolites that can be rapidly excreted via the kidneys and bile .
In addition, the drug metabolism is a inactivation system, since many metabolites are either ineffective or substantially weakened effect .
However, a number of metabolites from Phase I reactions themselves pharmacologically active metabolite, or is in the first place, the actual mechanism of action dar .
The functionalization reactions are mediated primarily by the cytochrome P450 CYP system, play a large family of enzymes, the enzymes in humans CYP3AFamilie of the most important role .
Among them, CYP3A4 is the most abundant in the liver enzyme.
CYP3A4 has very broad substrate specificity and is involved in the metabolism of more than 50% of all therapeutically used drugs .
It has been shown that the activity of CYP3A4 in adulthood in women by an average 20-50% higher than in men, the differences become more apparent with increasing age .
During pregnancy, the activity of CYP3A4 is increased .
Occasionally there are indications that the activity of other enzymes
the CYP family is higher in women than in men, although the differences are less pronounced and play these enzymes in drug metabolism is less important. Conversely, the activity seems to be some CYP enzymes to be less in women than in men .
In addition to the gender and inter-ethnic differences in enzyme activity are known. For example, Asians have, compared to Caucasians with a significantly lower activity of CYP3A4 .
Gender differences in activity were also detected in the course of conjugation .
The activity of enzymes glucuronidierender instance, seems to be lower in women than in men. The extent to which these complex gender differences in the metabolism of drugs in their profile of action is reflected depends ultimately on the one hand and the other enzymes involved in it, metabolized in the extent to which the respective drug is and how the metabolites are pharmacologically active .
IN WOMEN LESS DRUG TRANSPORT FROM THE LIVER :-
Gender differences are also known at the level of transport proteins. P-glycoprotein, active for the transport of drugs from the cell important transport protein seems to be present in women than in men, at least in the liver cells to a lesser extent .
The reduced transport of drugs from the liver cell can lead to a higher level of intracellular metabolism, such as by CYP3A4. In women is likely a lower activity of the transport system for organic cations in the kidney be at least its part in the decreased excretion of the kidney performance for some drugs. With the elimination of drugs by the kidney is to be noted further that - taking into account differences in body weight - the filtration capacity of the kidney in women average about 10% lower than in men .
Also pharmacodynamic differences :-
Recent studies suggest that gender differences are due to active drugs, at least in part by their different effects on the female and male body, so there are pharmacodynamic differences .
It is known that the analgesic effect of opioid analgesics acting strongly in women is more pronounced than in men .
Literature with the author Dr. Nabil Abdul Kadir DEEB .
see Dr. Nabil DEEB ,Gender & pharmacotherapy Acute coronary syndromes? .
Literature :
1. Dr. Nabil DEEB ,Gender & pharmacotherapy Acute coronary -nabildeeb,pmi, Dr. Nabil DEEB, GERMANY , Akute Koronarsyndrome & Geschlechtsspezifische Pharmakotherapie ! , GERMANY Bonn 15 . 02.2010 .
2. The rest of the literature is with the author Dr. Nabil DEEB .
3. The rest of the literature is with the author Dr. Nabil DEEB .
Dr. Nabil Abdul Kadir DEEB
Dr. Nabil Deeb
Doctor - Physician – Doctor
PMI Medical Association e.V.
Palestine Medico International Medical Society - (PMI) e.V.
Department of Medical Research
Département de la recherche médicale
P.O. Box 20 10 53
53 140 Bonn - Bad Godesberg / GERMANY
e.mail: [email protected]
or
e.mail: [email protected]
16/4/2012
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