The impact of gender in cardiovascular medicine: Lessons from the gender/sex-issue in heart failure

Marra, Alberto M.; Salzano, Andrea; Arcopinto, Michele; Piccioli, Lucrezia; Raparelli, Valeria

doi:10.4081/monaldi.2018.988

Cited by 17 publications

(12 citation statements)

References 63 publications

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“…However, women have been historically included in a smaller proportion (around 30%) than men in clinical trials, and their therapeutic management and prognosis have been less studied. All this leads to a lower prescription in women of the treatments recommended by clinical practice guidelines [12,31,[40][41][42] and, for reasons not entirely clear, with lower average drug doses [9,[43][44][45]. Although information on drug doses used and on the LVEF of our patients were not available in our cohort, we confirmed, in general, the lower prescription of the specific treatments for HF in women.…”

Section: Discussionsupporting

confidence: 75%

“…The higher prevalence of ischemic heart disease and arrhythmias in men would justify the greater dispensation of anti-coagulation and anti-aggregation treatments, in line with the results of Dewan et al [26], who also found a greater use of statins [6,41]. In other studies, greater side-effects related to ACE inhibitors have been reported for women, such as cough or angioedema [5,43,46,47]. In our sample, women had less arrhythmia and were also treated more frequently with digoxin than with beta-blockers, despite the greater association in women between use of digoxin and mortality and/or negative adverse effects [12,48,49].…”

Section: Discussionmentioning

confidence: 70%

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Sex Differences in Comorbidity, Therapy, and Health Services’ Use of Heart Failure in Spain: Evidence from Real-World Data

Gutiérrez

Poblador‐Plou

Prados‐Torres

et al. 2020

IJERPH

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Heart failure (HF) is becoming increasingly prevalent and affects both men and women. However, women have traditionally been underrepresented in HF clinical trials. In this study, we aimed to analyze sex differences in the comorbidity, therapy, and health services’ use of HF patients. We conducted a cross-sectional study in Aragón (Spain) and described the characteristics of 17,516 patients with HF. Women were more frequent (57.4 vs. 42.6%, p < 0.001) and older (83 vs. 80 years, p < 0.001) than men, and presented a 33% lower risk of 1-year mortality (p < 0.001). Both sexes showed similar disease burdens, and 80% suffered six or more diseases. Some comorbidities were clearly sex-specific, such as arthritis, depression, and hypothyroidism in women, and arrhythmias, ischemic heart disease, and COPD in men. Men were more frequently anti-aggregated and anti-coagulated and received more angiotensin-converting-enzyme (ACE) inhibitors and beta-blockers, whereas women had more angiotensin II antagonists, antiinflammatories, antidepressants, and thyroid hormones dispensed. Men were admitted to specialists (79.0 vs. 70.6%, p < 0.001), hospital (47.0 vs. 38.1%, p < 0.001), and emergency services (57.6 vs. 52.7%, p < 0.001) more frequently than women. Our results highlight the need to conduct future studies to confirm the existence of these differences and of developing separate HF management guidelines for men and women that take into account their sex-specific comorbidity.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 70%

Sex Differences in Comorbidity, Therapy, and Health Services’ Use of Heart Failure in Spain: Evidence from Real-World Data

Gutiérrez

Poblador‐Plou

Prados‐Torres

et al. 2020

IJERPH

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“…These differences might be attributed to the HF aetiology, left ventricular ejection fraction (HFrEF vs. HFpEF), and New York Health Association classifications, which were not available in this dataset. Women have a higher incidence of HF at older age, have more HFpEF, and suffer more from obesity, diabetes, and hypertension, while man have a higher incidence at a younger age with more HFrEF due to ischaemic aetiology 24 . Furthermore, women generally live longer than men.…”

Section: Discussionmentioning

confidence: 99%

“…Women have a higher incidence of HF at older age, have more HFpEF, and suffer more from obesity, diabetes, and hypertension, while man have a higher incidence at a younger age with more HFrEF due to ischaemic aetiology. 24 Furthermore, women generally live longer than men. In our study, women with RI, COPD/ asthma, and diabetes had a worse prognosis, even though prevalence of RI was not significantly different, and COPD/asthma and diabetes were more common among men.…”

Section: Co-morbiditiesmentioning

confidence: 99%

Impact of sex differences in co‐morbidities and medication adherence on outcome in 25 776 heart failure patients

et al. 2020

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Aims Health insurance claims (HIC) databases in the Netherlands capture unselected patient populations, which makes them suitable for epidemiological research on sex differences. Based on a HIC database, we aimed to reveal sex differences in heart failure (HF) outcomes, with particular focus on co‐morbidities and medication. Methods and results The Achmea HIC database included 14 517 men and 11 259 (45%) women with a diagnosis treatment code for chronic HF by January 2015. We related their sex, co‐morbidities, and medication adherence (medication possession rate >0.8) with the primary endpoint (PE) of all‐cause mortality or HF admission during a median follow‐up of 3.3 years, using Cox regression. Median age of men and women was 72 and 76 years, respectively. Prevalence of co‐morbidities and use of disease‐modifying drugs was higher in men; however, medication adherence was similar. At the end of follow‐up, 35.1% men and 31.8% women had reached the PE. The adjusted hazard ratio for men was 1.25 (95% confidence interval: 1.19–1.30). A broad range of co‐morbidities was associated with the PE. Overall, these associations were stronger in women than in men, particularly for renal insufficiency, chronic obstructive pulmonary disease/asthma, and diabetes. Non‐adherence to disease‐modifying drugs was related with a higher incidence of the PE, with similar effects between sexes. Conclusions In a representative sample of the Dutch population, as captured in a HIC database, men with chronic HF had a 25% higher incidence of death or HF admission than women. The impact of co‐morbidities on the outcome was sex dependent, while medication adherence was not.

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“…In adult patients, several studies have already demonstrated sex related differences in cardio-circulation (12)(13)(14). Sex related differences concerning pathophysiology, clinical features and therapy are more and more in the focus of research, since these differences may have an impact on clinical practice.…”

Section: Sex Related Difference In Cardiac Output During Neonatal Transition In Term Neonatesmentioning

confidence: 99%

Sex related difference in cardiac output during neonatal transition in term neonates

Baik‐Schneditz¹,

Schwaberger²,

Mileder³

et al. 2021

Cardiovasc Diagn Ther

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Background: The immediate transition from foetus to neonate includes substantial changes especially concerning the cardiovascular system. As sex related differences have been shown in cardiovascular medicine, this topic warrants further investigation in neonatology. Aim: The aim of this present study was to measure cardiac output (CO) and cerebral oxygenation (cTOI) non-invasively in term neonates and to investigate potential sex related differences between female and male neonates after birth.Methods: This is a mono-centric prospective observational study. For CO-measurements, the electrical velocimetry method was used. The pulse oximetry for arterial oxygen saturation and heart-rate measurements was placed on the right hand or wrist. cTOI was measured using a NIRO 200NX monitor. The near-infrared spectroscopy probe was positioned on the right side of forehead in each infant. Monitoring started at minute 1 and was continued until minute 15 after birth. At minutes 5, 10, and 15 after birth, CO was calculated as an average out of six 10-second periods.Results: 99 term neonates were enrolled. In our study population, we could identify 54 female and 45 male neonates. Males had higher cardiac output compared to females throughout the observational period, with a significant difference in minute 15 after birth (217, 95% CI: 203-231 mL/kg/min versus 178, 95% CI: 163-192 mL/kg/min; P<0.001). cTOI, SpO 2 , and HR did not differ between male and female neonates. Conclusions:The present work is the first to investigate sex related differences concerning cardiac output in term neonates during postnatal transition, showing a significantly higher cardiac output in male neonates 15 minutes after birth.

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The impact of gender in cardiovascular medicine: Lessons from the gender/sex-issue in heart failure

Cited by 17 publications

References 63 publications

Sex Differences in Comorbidity, Therapy, and Health Services’ Use of Heart Failure in Spain: Evidence from Real-World Data

Sex Differences in Comorbidity, Therapy, and Health Services’ Use of Heart Failure in Spain: Evidence from Real-World Data

Impact of sex differences in co‐morbidities and medication adherence on outcome in 25 776 heart failure patients

Sex related difference in cardiac output during neonatal transition in term neonates

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