Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ontario, Canada; Cardiology Postgraduate Program, McMaster University, Hamilton, Ontario, Canada.
Heart Failure and Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Can J Cardiol. 2021 Apr;37(4):560-571. doi: 10.1016/j.cjca.2020.12.025. Epub 2020 Dec 29.
Heart failure (HF) is a leading cause of hospitalisation, morbidity, and mortality in Canada. There are sex-specific differences in the etiology, epidemiology, comorbidities, treatment response, and treatment adverse effects that have implications on outcomes in HF. Sex-specific analyses of some HF trials indicate that optimal doses of drug therapies and benefit of device therapies may differ between male and female patients, but the trials were not designed to test sex differences. The under-representation of female participants in HF randomised controlled trials (RCTs) is a major limitation in assessing the sex-specific efficacy and safety of treatments. To ensure that female patients receive safe and effective HF therapies, RCTs should include participants proportionate to the sex-specific distribution of disease. This review outlines the sex-specific differences in HF phenotype and treatment response, and highlights disparities in services and gaps in knowledge that merit further investigation.
心力衰竭（HF）是加拿大住院、发病和死亡的主要原因。在病因、流行病学、合并症、治疗反应和治疗不良反应方面，存在着性别特异性差异，这些差异对 HF 的结局有影响。对一些 HF 试验的性别特异性分析表明，药物治疗的最佳剂量和器械治疗的获益可能在男性和女性患者之间存在差异，但这些试验并不是为了检验性别差异而设计的。HF 随机对照试验（RCT）中女性参与者的代表性不足是评估治疗性别特异性疗效和安全性的主要限制。为了确保女性患者接受安全有效的 HF 治疗，RCT 应包括与疾病性别特异性分布成比例的参与者。本综述概述了 HF 表型和治疗反应的性别特异性差异，并强调了服务方面的差异和知识方面的差距，这些都值得进一步研究。
