Sex-Related Differences in Heart Failure With Preserved Ejection Fraction.

Pubmed ID: 31813280

Journal: Circulation. Heart failure

Publication Date: Dec. 1, 2019

Affiliation: BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (P.D., R.R., R.T.C., L.S., P.S.J., M.C.P., J.J.V.M.).

Link: https://www.ahajournals.org/doi/pdf/10.1161/CIRCHEARTFAILURE.119.006539

MeSH Terms: Humans, Male, Adult, Female, Aged, Risk Factors, Middle Aged, Randomized Controlled Trials as Topic, Risk Assessment, Sex Factors, Heart Failure, Hospitalization, Disease Progression, Cause of Death, Prognosis, Quality of Life, Comorbidity, Stroke Volume, Health Status Disparities, Time Factors, Ventricular Function, Left, Evidence-Based Medicine, Death, Sudden, Cardiac

Authors: Pitt B, Zile MR, Solomon SD, Pfeffer MA, Swedberg K, Køber L, Granger CB, Komajda M, Campbell RT, Raparelli V, Jhund PS, Petrie MC, Desai AS, Shen L, McMurray JJV, McKelvie RS, Rørth R, Anand IS, Carson PE, Dewan P, O'Meara E

Cite As: Dewan P, Rørth R, Raparelli V, Campbell RT, Shen L, Jhund PS, Petrie MC, Anand IS, Carson PE, Desai AS, Granger CB, Køber L, Komajda M, McKelvie RS, O'Meara E, Pfeffer MA, Pitt B, Solomon SD, Swedberg K, Zile MR, McMurray JJV. Sex-Related Differences in Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2019 Dec;12(12):e006539. Epub 2019 Dec 9.

Studies:

Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT)

Abstract

BACKGROUND: To describe characteristics and outcomes in women and men with heart failure with preserved ejection fraction. METHODS: Baseline characteristics (including biomarkers and quality of life) and outcomes (primary outcome: composite of first heart failure hospitalization or cardiovascular death) were compared in 4458 women and 4010 men enrolled in CHARM-Preserved (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) (EF≥45%), I-Preserve (Irbesartan in heart failure with Preserved ejection fraction), and TOPCAT-Americas (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial). RESULTS: Women were older and more often obese and hypertensive but less likely to have coronary artery disease or atrial fibrillation. Women had more symptoms and signs of congestion and worse quality of life. Despite this, the risk of the primary outcome was lower in women (hazard ratio, 0.80 [95% CI, 0.73-0.88]), as was the risk of cardiovascular death (hazard ratio, 0.70 [95% CI, 0.62-0.80]), but there was no difference in the rate for first hospitalization for heart failure (hazard ratio, 0.92 [95% CI, 0.82-1.02]). The lower risk of cardiovascular death in women, compared with men, was in part explained by a substantially lower risk of sudden death (hazard ratio, 0.53 [0.43-0.65]; <i>P</i><0.001). E/A ratio was lower in women (1.1 versus 1.2). CONCLUSIONS: There are significant differences between women and men with heart failure with preserved ejection fraction. Despite worse symptoms, more congestion, and lower quality of life, women had similar rates of hospitalization and better survival than men. Their risk of sudden death was half that of men. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00853658, NCT01035255.