Department of Public Health and Clinical Medicine, Umeå University, S-901 87, Umeå, Sweden.
Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
Eur J Clin Pharmacol. 2020 Apr;76(4):539-546. doi: 10.1007/s00228-019-02782-2. Epub 2020 Jan 3.
The aims of this study were to examine sex differences in a heart failure population with regards to treatment and patient characteristics and to investigate the impact of sex on achieved doses of heart failure medications.
A total of 1924 patients with heart failure in a regional hospital were analysed, 622 patients had ejection fraction ≤ 40% of which 30% were women. In patients with reduced ejection fraction, women were older (79 ± 11 vs. 74 ± 12 years, P < 0.001), had lower body weight (70 ± 17 vs. 86 ± 18 kg, P < 0.001), lower estimated glomerular filtration rate (eGFR) (49 ± 24 vs. 71 ± 30 ml/min, P < 0.001) and received lower doses of heart failure medications than men. Multivariable linear regression on patients with reduced ejection fraction showed that sex was not associated with achieved dose of any heart failure medication. For angiotensin-converting enzyme inhibitors and angiotensin receptor blockers associated factors were eGFR, systolic blood pressure, age, ejection fraction, and heart rate. For beta-blockers associated factors were body weight, atrial fibrillation and age. For mineralocorticoid receptor antagonists associated factors were eGFR, serum potassium, age, systolic blood pressure, ejection fraction and heart rate.
Women with heart failure and reduced ejection fraction were prescribed lower doses of heart failure medications, were older, had worse renal function, and lower body weight than men. Sex was not independently associated with achieved doses of heart failure medications, instead age, renal function and body weight explained the differences in treatment.
本研究旨在探讨心力衰竭患者在治疗和患者特征方面的性别差异，并研究性别对心力衰竭药物剂量的影响。
共分析了一家地区医院的 1924 例心力衰竭患者，其中 622 例射血分数≤40%，其中 30%为女性。在射血分数降低的患者中，女性年龄更大（79±11 岁比 74±12 岁，P<0.001），体重更轻（70±17 千克比 86±18 千克，P<0.001），估算肾小球滤过率（eGFR）更低（49±24 毫升/分钟比 71±30 毫升/分钟，P<0.001），接受的心力衰竭药物剂量也低于男性。对射血分数降低的患者进行多变量线性回归分析显示，性别与任何心力衰竭药物的剂量无关。对于血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂，相关因素是 eGFR、收缩压、年龄、射血分数和心率。对于β受体阻滞剂，相关因素是体重、心房颤动和年龄。对于盐皮质激素受体拮抗剂，相关因素是 eGFR、血清钾、年龄、收缩压、射血分数和心率。
心力衰竭且射血分数降低的女性接受的心力衰竭药物剂量较低，年龄较大，肾功能更差，体重更轻。性别与心力衰竭药物的剂量无关，而是年龄、肾功能和体重解释了治疗差异。
