长期心力衰竭预后的性别差异：一项综合荟萃分析。

Sex differences in long-term heart failure prognosis: a comprehensive meta-analysis.

作者信息

Qiu Weida, Wang Wenbin, Wu Shiping, Zhu Yanchen, Zheng He, Feng Yingqing

机构信息

Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China.

School of Medicine, South China University of Technology, Guangzhou, China.

出版信息

Eur J Prev Cardiol. 2024 Dec 4;31(17):2013-2023. doi: 10.1093/eurjpc/zwae256.

DOI:10.1093/eurjpc/zwae256

PMID:39101475

Abstract

AIMS

Sex differences in the long-term prognosis of heart failure (HF) remain controversial, and there is a lack of comprehensive pooling of the sex differences in outcomes of HF. This study aims to characterize the sex differences in the long-term prognosis of HF and explore whether these differences vary by age, HF course, left ventricular ejection fraction, region, period of study, study design, and follow-up duration.

METHODS AND RESULTS

A systematic review was conducted using Medline, Embase, Web of Science, and the Cochrane Library, from 1 January 1990 to 31 March 2024. The primary outcome was all-cause mortality (ACM), and the secondary outcomes included cardiovascular mortality (CVM), hospitalization for HF (HHF), all-cause hospitalization, a composite of ACM and HHF, and a composite of CVM and HHF. Pooled hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were calculated using random-effects meta-analysis. Ninety-four studies (comprising 96 cohorts) were included in the meta-analysis, representing 706,247 participants (56.5% were men; the mean age was 71.0 years). Female HF patients had a lower risk of ACM (HR 0.83; 95% CI 0.80, 0.85; I2 = 84.9%), CVM (HR 0.84; 95% CI 0.79, 0.89; I2 = 70.7%), HHF (HR 0.94; 95% CI 0.89, 0.98; I2 = 84.0%), and composite endpoints (ACM + HHF: HR 0.89; 95% CI 0.83, 0.95; I2 = 80.0%; CVM + HHF: HR 0.85; 95% CI 0.77, 0.93; I2 = 87.9%) compared with males. Subgroup analysis revealed that the lower risk of mortality observed in women was more pronounced among individuals with long-course HF (i.e. chronic HF, follow-up duration > 2 years) or recruited in the randomized controlled trials (P for interaction < 0.05).

CONCLUSION

Female HF patients had a better prognosis compared with males, with lower risks of ACM, CVM, HHF, and composite endpoints. Despite the underrepresentation of female populations in HF clinical trials, their mortality benefits tended to be lower than in real-world settings.

REGISTRATION

PROSPERO: CRD42024526100.

摘要

目的

心力衰竭（HF）长期预后的性别差异仍存在争议，且缺乏对HF结局中性别差异的综合汇总分析。本研究旨在描述HF长期预后的性别差异，并探讨这些差异是否因年龄、HF病程、左心室射血分数、地区、研究时期、研究设计和随访时间而有所不同。

方法与结果

采用Medline、Embase、Web of Science和Cochrane图书馆进行系统评价，检索时间范围为1990年1月1日至2024年3月31日。主要结局为全因死亡率（ACM），次要结局包括心血管死亡率（CVM）、HF住院（HHF）、全因住院、ACM与HHF的复合结局以及CVM与HHF的复合结局。使用随机效应荟萃分析计算合并风险比（HR）及相应的95%置信区间（CI）。荟萃分析纳入了94项研究（包括96个队列），共706247名参与者（56.5%为男性；平均年龄71.0岁）。与男性相比，女性HF患者的ACM风险较低（HR 0.83；95%CI 0.80，0.85；I² = 84.9%）、CVM风险较低（HR 0.84；95%CI 0.79，0.89；I² = 70.7%）、HHF风险较低（HR 0.94；95%CI 0.89，0.98；I² = 84.0%）以及复合终点风险较低（ACM + HHF：HR 0.89；95%CI 0.83，0.95；I² = 80.0%；CVM + HHF：HR 0.85；95%CI 0.77，0.93；I² = 87.9%）。亚组分析显示，在HF病程较长（即慢性HF，随访时间>2年）的个体或随机对照试验中招募的个体中，女性观察到的较低死亡风险更为明显（交互作用P<0.05）。