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Geschlechtsverteilung aortaler Gefäßerkrankungen

Sex distribution of aortic diseases

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Zusammenfassung

Frauen und Männer sind unterschiedlich, auch in Bezug auf ihre Gefäße! Bei Patienten mit atherosklerotischen und entzündlichen Aortenerkrankungen lassen sich Geschlechtsunterschiede hinsichtlich Prävalenz, klinischer Manifestation, Therapieergebnisse und Prognose feststellen. Gefäßerkrankungen treten bei Männern häufiger und bei Frauen später auf. Auch die Krankheitsverläufe bei Aortenerkrankungen unterscheiden sich, da Frauen z. B. bei Aortendissektionen sowohl im Spontanverlauf als auch nach Therapie eine erhöhte Komplikationsrate aufweisen. In der getABI-Studie ergab sich bei Männern eine größere absolute 3-Jahres-Mortalität als bei Frauen. Die relative 3-Jahres-Mortalität (Vergleich mit/ohne AVK) war in Bezug auf die Ereignisse „kardiovaskulärer Tod“ und „zerebrovaskulärer Tod“ bei Frauen größer als bei Männern.

Im Langzeitverlauf nach 5 Jahren ist bei Frauen nach Operation eines abdominellen Aortenaneurysmas (AAA) die Mortalität höher. Erklärt wird dies mit einer höheren Komorbidität bei Frauen. Gegebenenfalls müssen Frauen nach Hochrisikooperationen, zu denen aortale Eingriffe gehören, länger auf der Intensivstation überwacht werden. Die geschlechtsspezifische Pharmakokinetik relevanter Begleitmedikamente und deren Einfluss auf die Ergebnisse der Aortenchirugie ist bisher unterschätzt worden. In Zukunft müssen diese Unterschiede vermehrt berücksichtigt werden und sollten die Indikationsstellung für operative und interventionelle Eingriffe sowie deren Nachbeobachtungen beeinflussen. Geschlechtsspezifische Unterschiede bei Aortenerkrankungen wurden bisher sowohl klinisch als auch wissenschaftlich vernachlässigt. Weitere Studien sind zwingend erforderlich.

Abstract

Men and women have different blood vessels! In patients with atherosclerotic and inflammatory disease affecting the aorta there are sex-related differences in prevalence, clinical manifestations, treatment results, and prognosis. Vascular disease is more frequent in men and has a later onset in women. The disease courses are also different, insofar as women for example have a higher complication rate after aortic dissections, both in the spontaneous course and after treatment. In the getABI study the absolute 3-year mortality was found to be higher in men than in women. The relative 3-year mortality (comparison with/without arterial occlusion) was higher in women than in men in terms of cardiovascular and cerebrovascular deaths.

In the long term, after 5 years, women have a higher mortality rate following surgical treatment of an abdominal aortic aneurysm. The higher incidence of comorbidities in women is cited to explain this. If appropriate, women must be monitored longer in intensive care after high-risk operations, which includes interventions on the aorta. The sex specificity of the pharmacokinetics of relevant medications and their influence on the results of aortic surgery have been underestimated up to now. In future more emphasis must be given to these differences, and they must be taken account of in decisions as to whether or not operative and interventional treatments are indicated and in the intensity and duration of patient monitoring after such treatments. Sex-specific differences in aortic illnesses have so far been neglected by both clinicians and research scientists. There is an urgent need for further studies.

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  1. Klinik für Gefäßchirurgie,Vaskuläre und Endovaskuläre Chirurgie, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    D. Böckler, U. Burger, K. Klemm & A. Hyhlik-Dürr

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  1. D. Böckler
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  2. U. Burger
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  4. A. Hyhlik-Dürr
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Correspondence to D. Böckler.

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Böckler, D., Burger, U., Klemm, K. et al. Geschlechtsverteilung aortaler Gefäßerkrankungen. Gefässchirurgie 12, 421–428 (2007). https://doi.org/10.1007/s00772-007-0561-9

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