Background: Among individuals with Type 2 diabetes (T2DM), cardiovascular disease (CVD) is the
leading cause of morbidity and mortality. Sex and gender differences (SGDs) in the cardiovascular consequences
of T2DM are relevant suggesting the need for a more aggressive CVD preventive strategy in diabetic women as
they lose the so-called "female advantage" in terms of CVD risk comparing with the nondiabetic population.
Multiple factors may explain the disproportion in CVD risk among women with diabetes comparing with diabetic
men or non-diabetic women. Both genetic and hormonal factors only partially explain SGDs in CVD risk in
diabetes. However, women likely reach diagnosis later and in worse conditions, they undergo both diagnostic and
therapeutic supports in lower percentage and, finally, they are not able to obtain therapeutic goals recommended
by guidelines. Concerning the cardiovascular system, diabetes amplifies the extent of damage at both micro- and
macrovascular level differently among sexes.
Methods: The aim of this review is to clarify, in a sex and gender perspective, the impact of diabetes in CVD risk
and to summarize the most important SGDs in CVD primary and secondary prevention strategies such as antiplatelet
drugs and statins.
Results: The efficacy of ASA and/or statins in secondary prevention is documented in both sexes independently
by the presence of T2DM. A different approach to CVD primary prevention with ASA using the age cut-off to
discriminate sex differences has been recommended. The use of statins for primary prevention in women should
be accurately monitored for the occurrence of myalgia and risk of developing diabetes.
Conclusion: A gender approach in CVD prevention strategies is urgently required to achieve a sensible reduction
of adverse CV events.