Sex Differences in Patients with Heart Failure with Reduced Ejection Fraction Combined with Anemia and Hyperuricemia: A Retrospective Case Study.

Objective: Heart failure with reduced ejection fraction (HFrEF) is associated with high mortality and morbidity. This study aimed to investigate sex differences in clinical characteristics, ventricular remodeling, cardiovascular risk factors, and prognosis among patients with HFrEF complicated by anemia and hyperuricemia.

Subjects and methods: We analyzed data from patients with HFrEF admitted to the Affiliated Hospital of Youjiang Medical University for Nationalities between January 1, 2018, and September 1, 2022. A total of 185 patients with HFrEF, anemia, and hyperuricemia (HU) were included. Laboratory and echocardiographic parameters were examined, and Cox regression analysis was used to identify prognostic risk factors. Clinical characteristics and prognostic factors were compared between sexes.

Results: Female patients had lower body weight, smaller body size, more severe anemia, and fewer ischemic causes of ventricular remodeling compared with male patients. Male patients had a higher prevalence of smoking and renal insufficiency. Serum uric acid predicted lower extremity venous thrombosis (area under the curve = 0.736). During a median follow-up of 21.78 months, no significant sex difference in cardiovascular events was observed. However, multivariate Cox proportional hazards analysis demonstrated sex-specific prognostic factors. The independent risk factors in males were body weight (HR = 1.035, 95% CI: 1.016-1.054, P = 0.001), total protein (HR = 0.965, 95% CI: 0.934-0.997, P = 0.031), albumin/globulin ratio (HR = 2.024, 95% CI: 1.093-3.749, P = 0.025), and atrial fibrillation (HR = 0.399, 95% CI: 0.254-0.627, P = 0.001). Independent risk factor in females was MCHC (HR = 1.037, 95% CI: 1.011-1.064, P = 0.005).

Conclusion: In patients with HFrEF, anemia, and HU, males and females exhibited distinct clinical characteristics and cardiovascular risk factors, despite having similar survival outcomes. These findings underscore the importance of addressing sex-specific risk profiles in the clinical management of HFrEF.