Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.
Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
JACC Heart Fail. 2019 Jun;7(6):505-515. doi: 10.1016/j.jchf.2019.03.011.
This study assessed sex-related differences in a large cohort of unselected patients with heart failure (HF) across the ejection fraction (EF) spectrum.
Females are under-represented in randomized clinical trials. Potential sex-related differences in HF may question the generalizability of trials.
In the Swedish Heart Failure Registry population multivariate Cox and logistic regression models were fitted to investigate differences in prognosis, prognostic predictors, and treatments across males and females.
Of 42,987 patients, 37% were females (55% with HF with preserved EF [HFpEF], 39% with HF with mid-range EF [HFmrEF], and 29% with HF with reduced EF [HFrEF]). Females were older and more symptomatic and more likely to have hypertension and kidney disease but less likely to have diabetes and ischemic heart disease. After adjustments, females were more likely to use beta-blockers and digoxin but less likely to receive HF device therapy. Crude mortality/HF hospitalization rates for HFpEF (hazard ratio [HR]: 1.16) and HFmrEF (HR: 1.14) were significantly higher in females but lower in females with HFrEF (HR: 0.95). After adjustments, the risk was significantly lower in females regardless of EF (HR: 0.80 in HFrEF, HR: 0.91 in HFmrEF, and HR: 0.93 in HFpEF). The main sex-related differences in prognostic predictors concerned diabetes in HFrEF and anemia in HFmrEF.
Males and females with HF showed different characteristics across the EF spectrum. Males reported a lower crude risk of mortality/morbidity in HFpEF and HFmrEF but higher risk of HFrEF, although after adjustments, prognosis was better in females regardless of EF. The observed sex-related differences highlight the need for an adequate representation of females in HF randomized controlled trials to improve generalizability.
本研究评估了射血分数（EF）谱中大量未经选择的心力衰竭（HF）患者的性别相关差异。
女性在随机临床试验中代表性不足。HF 中潜在的性别相关差异可能会对试验的普遍性提出质疑。
在瑞典心力衰竭登记处人群中，使用多变量 Cox 和逻辑回归模型来研究男性和女性之间预后、预后预测因素和治疗的差异。
在 42987 名患者中，37%为女性（55%为射血分数保留的心力衰竭[HFpEF]，39%为射血分数中间范围的心力衰竭[HFmrEF]，29%为射血分数降低的心力衰竭[HFrEF]）。女性年龄较大，症状更明显，更有可能患有高血压和肾脏疾病，但更不可能患有糖尿病和缺血性心脏病。调整后，女性更有可能使用β受体阻滞剂和地高辛，但不太可能接受 HF 装置治疗。HFpEF（风险比[HR]：1.16）和 HFmrEF（HR：1.14）的女性死亡率/HF 住院率较高，但 HFrEF 女性死亡率/HF 住院率较低（HR：0.95）。调整后，无论 EF 如何，女性的风险均显著降低（HFrEF 中 HR：0.80，HFmrEF 中 HR：0.91，HFpEF 中 HR：0.93）。预后预测因素中的主要性别相关差异涉及 HFrEF 中的糖尿病和 HFmrEF 中的贫血。
HF 男性和女性在 EF 谱中表现出不同的特征。男性报告 HFpEF 和 HFmrEF 的死亡率/发病率风险较低，但 HFrEF 风险较高，但调整后，无论 EF 如何，女性的预后都更好。观察到的性别相关差异强调了在 HF 随机对照试验中充分代表女性的必要性，以提高普遍性。
