Sex differences in pulmonary arterial hypertension: Insights from the FOCUS-PAH registry

IF 3.2 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Matteo Pagnesi , Mauro Riccardi , Giulio Savonitto , Pietro Ameri , Simonetta Monti , Mauro Driussi , Piero Gentile , Claudia Specchia , Chiara Oriecuia , Marianna Adamo , Matteo Toma , Alberto Giannoni , Emma Di Poi , Luciana D'Angelo , Valentina Colombo , Veronica Vecchiato , Edoardo Airo , Massimo Imazio , Andrea Garascia , Gianfranco Sinagra , Carlo Mario Lombardi
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引用次数: 0

Abstract

Background

Despite the higher incidence of pulmonary arterial hypertension (PAH) in women, sex differences in terms of clinical presentation and prognosis are still uncertain. We assess the impact of sex in patients with PAH.

Methods

Sex differences were evaluated in the multicenter FOCUS-PAH registry, that included patients diagnosed with PAH at 7 tertiary care centers between 2001 and 2022. Patients' characteristics and outcomes were compared in men vs. women, and factors independently associated with long-term outcomes were assessed. The primary endpoint was overall survival.

Results

Among 410 included patients, 273 (66.6 %) were women and 137 (33.4 %) were men. Despite similar age, men had more cardio-renal-metabolic comorbidities and history of HIV infection, whereas women had more connective tissue disorders and scleroderma, and worse functional capacity. Dual therapy was more commonly prescribed in women (39.9 % vs. 27.0 %). At multivariable Cox regression analysis, female sex was independently associated with a lower risk of all-cause mortality (adjusted hazard ratio 0.60, 95 % confidence interval 0.38–0.95, p = 0.031). Age, European Society of Cardiology (ESC) / European Respiratory Society (ERS) risk score, glomerular filtration rate and scleroderma were independently associated with long-term mortality in women, whereas only age and ESC/ERS risk score independently predicted this endpoint in men.

Conclusions

In this real-world registry, women represented 2 out of 3 patients with PAH and female sex was independently associated with a lower risk of mortality. There were differences in the variables associated with long-term mortality between sexes, suggesting that individualized approach to risk stratification should also include sex.
肺动脉高压的性别差异:来自FOCUS-PAH登记的见解。
背景:尽管肺动脉高压(PAH)在女性中的发病率较高,但在临床表现和预后方面的性别差异仍不确定。我们评估性别对PAH患者的影响。方法:在多中心FOCUS-PAH登记中评估性别差异,其中包括2001年至2022年间在7个三级保健中心诊断为PAH的患者。比较了男性和女性患者的特征和结果,并评估了与长期结果独立相关的因素。主要终点是总生存期。结果:纳入的410例患者中,女性273例(66.6% %),男性137例(33.4% %)。尽管年龄相近,但男性有更多的心脏-肾脏代谢合并症和HIV感染史,而女性有更多的结缔组织疾病和硬皮病,功能能力更差。双重治疗在女性中更为常见(39.9 % vs. 27.0 %)。在多变量Cox回归分析中,女性与较低的全因死亡风险独立相关(调整后的风险比0.60,95 %置信区间0.38-0.95,p = 0.031)。年龄、欧洲心脏病学会(ESC) /欧洲呼吸学会(ERS)风险评分、肾小球滤过率和硬皮病与女性的长期死亡率独立相关,而男性只有年龄和ESC/ERS风险评分独立预测这一终点。结论:在这个真实世界的登记中,女性代表了3例PAH患者中的2例,并且女性与较低的死亡风险独立相关。与长期死亡率相关的变量在性别之间存在差异,这表明风险分层的个体化方法也应包括性别。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International journal of cardiology
International journal of cardiology 医学-心血管系统
CiteScore
6.80
自引率
5.70%
发文量
758
审稿时长
44 days
期刊介绍: The International Journal of Cardiology is devoted to cardiology in the broadest sense. Both basic research and clinical papers can be submitted. The journal serves the interest of both practicing clinicians and researchers. In addition to original papers, we are launching a range of new manuscript types, including Consensus and Position Papers, Systematic Reviews, Meta-analyses, and Short communications. Case reports are no longer acceptable. Controversial techniques, issues on health policy and social medicine are discussed and serve as useful tools for encouraging debate.
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