Paula Rambarat, Tyler Erickson, Derek Cyr, Jonathan Ward, Adrian Hernandez, David Morrow, Randall Starling, Eric Velazquez, Shelley Zieroth, Kristin Williamson, Scott Solomon, Robert Mentz
{"title":"血管紧张素-肾上腺素抑制对女性和男性的影响：来自PARAGLIDE-HF的见解。","authors":"Paula Rambarat, Tyler Erickson, Derek Cyr, Jonathan Ward, Adrian Hernandez, David Morrow, Randall Starling, Eric Velazquez, Shelley Zieroth, Kristin Williamson, Scott Solomon, Robert Mentz","doi":"10.1016/j.ahj.2025.03.017","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Sub-analyses of key trials suggest a preferential benefit for specific heart failure with preserved ejection fraction (HFpEF) therapies in women. This work investigated treatment effects between women and men in the PARAGLIDE-HF (Prospective comparison of ARNI with ARB Given following stabiLization In DEcompensated HFpEF) trial.</p><p><strong>Methods: </strong>In this pre-specified subgroup analysis, we examined outcomes according to sex in the PARAGLIDE-HF trial. The primary endpoint was time-average proportional change in amino terminal pro-B type natriuretic peptide (NT-proBNP) from baseline through Weeks 4 and 8. We also examined secondary outcomes and tolerability.</p><p><strong>Results: </strong>Overall, 242 women (52%) and 224 men (48%) were randomized. Women had significantly higher LVEF, worse renal function, and less comorbidities than men. In the overall population, the time-averaged reduction in NT-proBNP was significantly greater for sacubitril/valsartan (sac/val) than valsartan (ratio of change 0.85, 95% CI:0.73-0.999). When examined according to sex, the time-averaged reduction in NT-proBNP was numerically greater with sac/val in both women (ratio of change=0.86, 95% CI: 0.69-1.070) and men (ratio of change 0.84, 95% CI: 0.67-1.05) with no differential treatment effect (P interaction=0.91). Similarly, the secondary hierarchical endpoint favored sac/val over valsartan in both women and men but was not statistically significant. Study drug dosage levels were similar across women and men and there were no sex-specific differences in the incidence of adverse events.</p><p><strong>Conclusions: </strong>In patients with mildly reduced or preserved EF > 40% and a recent worsening HF event, the efficacy, safety and tolerability of sac/val versus valsartan were similar in both women and men, suggesting consistent effects across appropriately selected patients regardless of sex. Future prospective studies are needed to further evaluate sex-specific differences in treatment response of HFpEF therapies.</p><p><strong>Trial registration: </strong>Prospective comparison of ARNI with ARB Given following stabiLization In DEcompensated HFpEF; NCT03988634; https://www.</p><p><strong>Clinicaltrials: </strong>gov/study/NCT03988634.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effects of angiotensin-neprilysin inhibition in women versus men: Insights from PARAGLIDE-HF.\",\"authors\":\"Paula Rambarat, Tyler Erickson, Derek Cyr, Jonathan Ward, Adrian Hernandez, David Morrow, Randall Starling, Eric Velazquez, Shelley Zieroth, Kristin Williamson, Scott Solomon, Robert Mentz\",\"doi\":\"10.1016/j.ahj.2025.03.017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Sub-analyses of key trials suggest a preferential benefit for specific heart failure with preserved ejection fraction (HFpEF) therapies in women. This work investigated treatment effects between women and men in the PARAGLIDE-HF (Prospective comparison of ARNI with ARB Given following stabiLization In DEcompensated HFpEF) trial.</p><p><strong>Methods: </strong>In this pre-specified subgroup analysis, we examined outcomes according to sex in the PARAGLIDE-HF trial. The primary endpoint was time-average proportional change in amino terminal pro-B type natriuretic peptide (NT-proBNP) from baseline through Weeks 4 and 8. We also examined secondary outcomes and tolerability.</p><p><strong>Results: </strong>Overall, 242 women (52%) and 224 men (48%) were randomized. Women had significantly higher LVEF, worse renal function, and less comorbidities than men. In the overall population, the time-averaged reduction in NT-proBNP was significantly greater for sacubitril/valsartan (sac/val) than valsartan (ratio of change 0.85, 95% CI:0.73-0.999). When examined according to sex, the time-averaged reduction in NT-proBNP was numerically greater with sac/val in both women (ratio of change=0.86, 95% CI: 0.69-1.070) and men (ratio of change 0.84, 95% CI: 0.67-1.05) with no differential treatment effect (P interaction=0.91). Similarly, the secondary hierarchical endpoint favored sac/val over valsartan in both women and men but was not statistically significant. Study drug dosage levels were similar across women and men and there were no sex-specific differences in the incidence of adverse events.</p><p><strong>Conclusions: </strong>In patients with mildly reduced or preserved EF > 40% and a recent worsening HF event, the efficacy, safety and tolerability of sac/val versus valsartan were similar in both women and men, suggesting consistent effects across appropriately selected patients regardless of sex. 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Effects of angiotensin-neprilysin inhibition in women versus men: Insights from PARAGLIDE-HF.
Background: Sub-analyses of key trials suggest a preferential benefit for specific heart failure with preserved ejection fraction (HFpEF) therapies in women. This work investigated treatment effects between women and men in the PARAGLIDE-HF (Prospective comparison of ARNI with ARB Given following stabiLization In DEcompensated HFpEF) trial.
Methods: In this pre-specified subgroup analysis, we examined outcomes according to sex in the PARAGLIDE-HF trial. The primary endpoint was time-average proportional change in amino terminal pro-B type natriuretic peptide (NT-proBNP) from baseline through Weeks 4 and 8. We also examined secondary outcomes and tolerability.
Results: Overall, 242 women (52%) and 224 men (48%) were randomized. Women had significantly higher LVEF, worse renal function, and less comorbidities than men. In the overall population, the time-averaged reduction in NT-proBNP was significantly greater for sacubitril/valsartan (sac/val) than valsartan (ratio of change 0.85, 95% CI:0.73-0.999). When examined according to sex, the time-averaged reduction in NT-proBNP was numerically greater with sac/val in both women (ratio of change=0.86, 95% CI: 0.69-1.070) and men (ratio of change 0.84, 95% CI: 0.67-1.05) with no differential treatment effect (P interaction=0.91). Similarly, the secondary hierarchical endpoint favored sac/val over valsartan in both women and men but was not statistically significant. Study drug dosage levels were similar across women and men and there were no sex-specific differences in the incidence of adverse events.
Conclusions: In patients with mildly reduced or preserved EF > 40% and a recent worsening HF event, the efficacy, safety and tolerability of sac/val versus valsartan were similar in both women and men, suggesting consistent effects across appropriately selected patients regardless of sex. Future prospective studies are needed to further evaluate sex-specific differences in treatment response of HFpEF therapies.
Trial registration: Prospective comparison of ARNI with ARB Given following stabiLization In DEcompensated HFpEF; NCT03988634; https://www.
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The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.
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