{"doi":"10.3389/fcvm.2024.1420293","title":"Editorial: Sex differences and cardiovascular therapeutics","abstract":"Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality worldwide [1]. Sex and gender as a biological variable, are crucial factors that impact every aspect of clinical and public health practice and research [2][3][4]. In recent times, research investigating sex differences has gained more attention, partly benefit from federal agencies emphasizing the importance of considering sex as a significant biological factor [5]. Within cardiovascular medicine, sex and gender affect disease presentation, pathophysiology, diagnostic assessment, responses to treatments, and overall health outcomes [6,7]. Historically, CVD has been perceived as primarily affecting men; however, it is increasingly recognized as a leading cause of morbidity and mortality in women as well [8]. While men tend to develop CVD earlier in life, CVD prevalence increases significantly in postmenopausal women, narrowing the gap between the sexes [9]. Men have traditionally experienced higher rates of CVD-related events, but women are more likely to die following an acute cardiovascular event [10]. The existence of these gender disparities has prompted significant attention, highlighting the crucial significance of considering gender variations in the prevention, diagnosis, treatment, and overall management of CVD [11].Traditional risk factors such as hypertension, diabetes, dyslipidemia, and smoking affect both sexes, but their impacts can vary between men and women [12][13][14]. Additionally, women may experience unique risk factors including pregnancy-related complications such as gestational diabetes and preeclampsia, as well as endocrine disorders in reproductive age such as polycystic ovary syndrome (PCOS) and early menopause, which are associated with accelerated development of CVD and impaired CVD-free survival [15][16][17]. Biological differences include genetic differences, variation in sex hormonal status, vascular anatomy, endothelial function, and plaque composition, which contribute to differences in the pathophysiology of CVD between men and women [18,19]. Women showed less plaque inflammatory infiltration compared to plaques from age-matched men [20][21][22]. In addition, women often undergo fewer diagnostic tests and experience delays in diagnosis compared to men, leading to disparities in timely intervention and treatment [23]. Despite accumulating evidence, the precise roles of biological sex and the sociocultural aspect of gender in the development and consequences of CVDs have not been fully explained. The interplay between sex-specific disparities in genetic and hormonal mechanisms and the intricate nature of gender, including its various components and influencing factors, which give rise to different disease patterns in men and women, requires further investigation.The extents to which biological factors, such as genes and hormones, contribute to cardiovascular traits and outcomes are still not fully grasped. Heightened recognition of gender's impact has prompted endeavors to assess gender in both retrospective and prospective clinical studies, leading to the creation of gender scores. Yet, the combined or conflicting influences of sex and gender on cardiovascular characteristics, as well as on the mechanisms underlying CVDs, have not been systematically elucidated. The majority of medication are withdrawn after FDA approval due to unexpected adverse effects in women [24]. Additionally, there are differences in the effectiveness and side effects of cardiovascular medications between men and women [25]. Current guidelines do not provide sex-specific recommendations on the use of antithrombotic drugs in patients with coronary artery disease. Nevertheless, the effectiveness of antithrombotic medications might be impacted by genetic and biological factors associated to sex [26]. Women generally exhibit greater platelet reactivity at baseline and in response to low-dose aspirin treatment in comparison to men [27]. 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