García-Cosío María Dolores, González-Vilchez Francisco, López-Vilella Raquel, Barge-Caballero Eduardo, Gómez Bueno Manuel, Martínez-Selles Manuel, María Arizón Jose, Rangel Sousa Diego, González-Costello José, Mirabet Sonia, Pérez-Villa Félix, Molina Beatriz Díaz, Rábago Gregorio, Portolés Ocampo Ana, de la Fuente Galán Luis, Garrido Iris, Delgado Juan F
Servicio de Cardiología, Hospital 12 de Octubre Madrid, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.
Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Madrid, Spain.
Front Cardiovasc Med. 2021 Feb 25;8:630113. doi: 10.3389/fcvm.2021.630113. eCollection 2021.
Biological differences between males and females change the course of different diseases and affect therapeutic measures' responses. Heart failure is not an exception to these differences. Women account for a minority of patients on the waiting list for heart transplantation or other advanced heart failure therapies. The reason for this under-representation is unknown. Men have a worse cardiovascular risk profile and suffer more often from ischemic heart disease. Conversely, transplanted women are younger and more frequently have non-ischemic cardiac disorders. Women's poorer survival on the waiting list for heart transplantation has been previously described, but this trend has been corrected in recent years. The use of ventricular assist devices in women is progressively increasing, with comparable results than in men. The indication rate for a heart transplant in women (number of women on the waiting list for millions of habitants) has remained unchanged over the past 25 years. Long-term results of heart transplants are equal for both men and women. We have analyzed the data of a national registry of heart transplant patients to look for possible future directions for a more in-depth study of sex differences in this area. We have analyzed 1-year outcomes of heart transplant recipients. We found similar results in men and women and no sex-related interactions with any of the factors related to survival or differences in death causes between men and women. We should keep trying to approach sex differences in prospective studies to confirm if they deserve a different approach, which is not supported by current evidence.
男性和女性之间的生物学差异改变了不同疾病的病程，并影响治疗措施的反应。心力衰竭在这些差异方面也不例外。在心脏移植或其他晚期心力衰竭治疗的等待名单上，女性患者占少数。这种代表性不足的原因尚不清楚。男性的心血管风险状况更差，患缺血性心脏病的频率更高。相反，接受移植的女性更年轻，更常患有非缺血性心脏疾病。此前已有报道称女性在心脏移植等待名单上的生存率较低，但近年来这种趋势已得到纠正。女性使用心室辅助装置的情况正在逐渐增加，其结果与男性相当。在过去25年中，女性心脏移植的指征率（每百万居民中在等待名单上的女性人数）保持不变。心脏移植的长期结果在男性和女性中是相同的。我们分析了一个全国性心脏移植患者登记处的数据，以寻找在该领域更深入研究性别差异的可能未来方向。我们分析了心脏移植受者的1年预后情况。我们在男性和女性中发现了相似的结果，并且在与生存相关的任何因素或男性和女性死亡原因差异方面没有发现与性别相关的相互作用。我们应该继续在前瞻性研究中探讨性别差异，以确认它们是否值得采用不同的方法，而目前的证据并不支持这一点。
