Sex Differences in Patients With Chronic Heart Failure With Reference to Left Ventricular Ejection Fraction

Y. Sakata, S. Miyata, Kotaro Nochioka, M. Miura, T. Shiroto, H. Shimokawa
{"title":"Sex Differences in Patients With Chronic Heart Failure With Reference to Left Ventricular Ejection Fraction","authors":"Y. Sakata, S. Miyata, Kotaro Nochioka, M. Miura, T. Shiroto, H. Shimokawa","doi":"10.1177/2470289718787115","DOIUrl":null,"url":null,"abstract":"Background: Data on sex differences in heart failure (HF) with reference to left ventricular ejection fraction (LVEF) are limited. Methods and Materials: We examined 4683 consecutive patients (mean 69 years) with HF in the CHART-2 study. Results: Compared to men (N = 3188), women with HF (N = 1495) were older and had a lower prevalence of ischemic heart disease and cancer, received less implementation of evidence-based treatment, and were characterized by more severe HF in terms of higher New York Heart Association (NYHA) functional class and increased brain natriuretic peptide (BNP) levels, despite greater preservation of LVEF. During the median 6.3-year follow-up, all-cause mortality was comparable between women and men (32.8% vs 33.2%, P = .816), while women had higher cardiovascular mortality, particularly among those with LVEF ≥50%. Although no sex differences existed in cause of death among patients with LVEF ≤ 40% and 41% to 49%, women had a higher proportion of cardiovascular death and lower proportion of noncardiovascular death than men among those with LVEF ≥ 50%. Multivariable Cox regression models showed that women with HF had reduced risk of both cardiovascular and noncardiovascular death, regardless of LVEF category. Beta-blockers were associated with improved mortality in women but not men with LVEF ≤ 40%, while renin–angiotensin system inhibitors were not associated with improved mortality in women with LVEF ≥ 50% but were in men. Conclusion: In addition to sex-specific differences in the age of onset, etiology and response to treatment, women with heart failure and preserved left ventricular ejection fraction (LVEF ≥ 50%) have higher cardiovascular mortality than men. Sex-related management of congestive heart failure should include a consideration of LVEF.","PeriodicalId":32801,"journal":{"name":"Gender and the Genome","volume":"2 1","pages":"27 - 42"},"PeriodicalIF":0.0000,"publicationDate":"2018-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2470289718787115","citationCount":"2","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gender and the Genome","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/2470289718787115","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 2

Abstract

Background: Data on sex differences in heart failure (HF) with reference to left ventricular ejection fraction (LVEF) are limited. Methods and Materials: We examined 4683 consecutive patients (mean 69 years) with HF in the CHART-2 study. Results: Compared to men (N = 3188), women with HF (N = 1495) were older and had a lower prevalence of ischemic heart disease and cancer, received less implementation of evidence-based treatment, and were characterized by more severe HF in terms of higher New York Heart Association (NYHA) functional class and increased brain natriuretic peptide (BNP) levels, despite greater preservation of LVEF. During the median 6.3-year follow-up, all-cause mortality was comparable between women and men (32.8% vs 33.2%, P = .816), while women had higher cardiovascular mortality, particularly among those with LVEF ≥50%. Although no sex differences existed in cause of death among patients with LVEF ≤ 40% and 41% to 49%, women had a higher proportion of cardiovascular death and lower proportion of noncardiovascular death than men among those with LVEF ≥ 50%. Multivariable Cox regression models showed that women with HF had reduced risk of both cardiovascular and noncardiovascular death, regardless of LVEF category. Beta-blockers were associated with improved mortality in women but not men with LVEF ≤ 40%, while renin–angiotensin system inhibitors were not associated with improved mortality in women with LVEF ≥ 50% but were in men. Conclusion: In addition to sex-specific differences in the age of onset, etiology and response to treatment, women with heart failure and preserved left ventricular ejection fraction (LVEF ≥ 50%) have higher cardiovascular mortality than men. Sex-related management of congestive heart failure should include a consideration of LVEF.
慢性心力衰竭患者左心室射血分数的性别差异
背景:关于心力衰竭(HF)患者左心室射血分数(LVEF)的性别差异的数据有限。方法和材料:我们在CHAT-2研究中检查了4683名连续的HF患者(平均69岁)。结果:与男性(N=3188)相比,患有HF的女性(N=1495)年龄较大,缺血性心脏病和癌症的患病率较低,接受循证治疗较少,尽管LVEF保存较好,但在纽约心脏协会(NYHA)功能分级较高和脑钠尿肽(BNP)水平升高方面,HF更严重。在中位6.3年的随访中,女性和男性的全因死亡率相当(32.8%对33.2%,P=.816),而女性的心血管死亡率较高,尤其是LVEF≥50%的女性。尽管LVEF≤40%和41%至49%的患者的死因不存在性别差异,但在LVEF≥50%的患者中,女性心血管死亡比例高于男性,非心血管死亡比例低于男性。多变量Cox回归模型显示,无论LVEF类别如何,HF患者的心血管和非心血管死亡风险均降低。在LVEF≤40%的女性中,β受体阻滞剂与死亡率的改善相关,而在LVEF≥50%的女性中肾素-血管紧张素系统抑制剂与死亡率的提高无关,而在男性中。结论:除了发病年龄、病因和治疗反应方面的性别特异性差异外,患有心力衰竭和左心室射血分数(LVEF≥50%)的女性心血管死亡率高于男性。充血性心力衰竭的性别相关治疗应考虑LVEF。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
审稿时长
5 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信