Department of Medicine, QE, II Health Sciences Centre, Halifax, Canada.
Research Methods Unit, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada.
Int J Cardiol. 2017 Oct 1;244:169-174. doi: 10.1016/j.ijcard.2017.06.041. Epub 2017 Jun 13.
Post-hoc analyses of clinical trials and population-based studies have shown no difference in mortality between men and women, but often show that men are more likely to receive appropriate ICD therapy. We utilized a population-based registry to investigate the interaction of sex and age and the occurrence of ventricular arrhythmia in an ICD population.
A total of 776 consecutive patients receiving an ICD for primary or secondary prevention in a provincial ICD registry were studied. No significant mortality difference was found between men and women (27.5% versus 23.7%, p=0.39). Overall, men were more likely to receive appropriate ICD therapy compared to women (39.3% versus 26.7%, p=0.006). The hazard ratio for appropriate therapy in men vs. women <60years of age was 3.22, CI 95% (1.56-6.65), p=0.002, and the same comparison in men vs. women over the age of 60 showed no significant difference (HR 1.11, CI 95% [0.74-1.65], p=0.61). This interaction between age and sex remained significant when adjusted for New York Heart Associated Class, ejection fraction, coronary artery disease and indication for ICD (p=0.02).
This study demonstrates that the risk of appropriate ICD therapy increases as women are older, reaching similar risk as men in that age group. Further study of the mechanism of the interaction of age and sex as they modulate the occurrence of ventricular arrhythmia may be warranted.
临床试验和基于人群的研究的事后分析表明，男性和女性的死亡率没有差异，但通常表明男性更有可能接受适当的 ICD 治疗。我们利用基于人群的登记处调查了 ICD 人群中心律失常发生的性别和年龄的相互作用。
共研究了省级 ICD 登记处中因原发性或继发性预防而接受 ICD 的 776 例连续患者。男性和女性之间未发现死亡率有显著差异（27.5%比 23.7%，p=0.39）。总体而言，男性比女性更有可能接受适当的 ICD 治疗（39.3%比 26.7%，p=0.006）。<60 岁的男性与女性相比，适当治疗的风险比为 3.22，95%CI（1.56-6.65），p=0.002，而在 60 岁以上的男性与女性相比，没有显著差异（HR 1.11，95%CI [0.74-1.65]，p=0.61）。当调整纽约心脏协会（NYHA）分级、射血分数、冠心病和 ICD 适应证后，这种年龄和性别之间的相互作用仍然显著（p=0.02）。
本研究表明，随着女性年龄的增长，接受适当 ICD 治疗的风险增加，在该年龄组中，女性的风险与男性相似。可能需要进一步研究年龄和性别相互作用作为调节心律失常发生的机制。
