Klabník A, Murín J
Kardiologické oddelenie Stredoslovenského ústavu srdcových a cievnych chorôb, Banská Bystrica, Slovenská republika.
Vnitr Lek. 2009 Dec;55(12):1167-72.
At this point, guidelines recommend the same care for patients with chronic heart failure (HF), regardless of gender. In the future, however, HF care may need to be tailored by sex, as the best way to optimize outcomes for both men and women. Because prior studies demonstrated sex-related differences in many aspects of HF care (in the appropriate use and dosing of evidence-based therapy and in the individual response to pharmacological treatment between women and men with HF). In general, benefit of beta-blockers, ACE inhibitors, angiotensin II receptor blockers (ARBs) and spironolactone in clinical trials was similar, regardless ofgender. Women with HF appear to have significantly lower mortality rates on ARBs than on the more standard HF therapy (ACE inhibitors), but there was no difference in survival in men prescribed ARBs compared to ACE inhibitors. In a post hoc subgroup analysis digoxin was associated with a increased risk of death from any cause among women with HF, but not men. ACE inhibitor-induced cough was more frequent among women. The risk ofhyperkalemia was increased with male gender in HF patients treated with candesartan. The use ofspironolactone was inversely associated with fractures in men with CHF. Previous studies have suggested that female with HF are less likely received guideline-recommended therapies (in appropriate doses). Female patients with HF were less likely to receive certain guideline-recommended evidence-based treatments, but the influence of patient sex on delivery of these therapies was disappeared when the objective reasons for non-using of these therapies were taken into account. These sex differences could have potential widespread implications for routine heart failure care.
目前，指南建议对慢性心力衰竭（HF）患者给予相同的治疗，无论性别如何。然而，未来HF治疗可能需要根据性别进行调整，这是优化男性和女性治疗效果的最佳方法。因为先前的研究表明，HF治疗的许多方面存在性别差异（在循证治疗的合理使用和剂量方面，以及HF男性和女性对药物治疗的个体反应方面）。一般来说，在临床试验中，β受体阻滞剂、血管紧张素转换酶抑制剂（ACE抑制剂）、血管紧张素II受体阻滞剂（ARB）和螺内酯的益处相似，无论性别如何。患有HF的女性使用ARB时的死亡率似乎明显低于使用更标准的HF治疗（ACE抑制剂）时，但与使用ACE抑制剂的男性相比，使用ARB的男性生存率没有差异。在一项事后亚组分析中，地高辛与HF女性任何原因导致的死亡风险增加相关，但与男性无关。ACE抑制剂引起的咳嗽在女性中更常见。在用坎地沙坦治疗的HF患者中，男性高钾血症风险增加。螺内酯的使用与CHF男性的骨折呈负相关。先前的研究表明，患有HF的女性不太可能接受指南推荐的治疗（适当剂量）。患有HF的女性患者不太可能接受某些指南推荐的循证治疗，但当考虑不使用这些治疗的客观原因时，患者性别对这些治疗实施的影响就消失了。这些性别差异可能对常规心力衰竭护理产生潜在的广泛影响。
