Despite recent advancements in managing HF, research shows that the 5-year mortality rate continues to be high, ranging from 30% to 50% in clinical studies. “A growing body of research on HF has yielded inconclusive findings regarding the prognoses of women compared to men, particularly across different cardiomyopathies,” says Antonio P. Mansur, MD, PhD. “However, studies have consistently demonstrated that individuals with ischemic cardiomyopathies (iCMP) tend to experience higher mortality rates than those with nonischemic cardiomyopathies (niCMP), with men facing a more unfavorable prognosis than women.”
Sex-Related Differences in Mortality & Predictors of Death
For a retrospective study published in the Journal of Clinical Medicine, Dr. Mansur and colleagues analyzed mortality rates and identified predictors of death in women and men diagnosed with iCMP and niCMP. “Our primary objective was to identify the key determinants of mortality in both women and men with both iCMP and niCMP,” Dr. Mansur says. “By gaining a comprehensive understanding of prognosis and the factors contributing to mortality, we may be able to advance the field of sex-based prevention in cardiovascular medicine. Ultimately, our goal is to enhance the prevention of cardiovascular events and reduce all-cause mortality rates in women and men facing HF.”
Investigators reviewed clinical features and echocardiographic findings in 7,487 patients diagnosed with chronic HF between February 2017 and September 2020. The study included participants diagnosed with HF based on Framingham criteria for an HF diagnosis and echocardiographic measurements. The average age of the study group was 64.3 years, and 59% of the participants were men.
Fewer Deaths in Women With HF Due to iCMP
Study results showed that women with iCMP and niCMP had a significantly higher mean age, a higher mean left ventricular ejection fraction (LVEF), and a smaller left ventricular diastolic diameter than men. Over a follow-up of 2.26 years, 14.7% of women and 15.7% of men with niCMP died. During the same follow-up period, 24.5% of women and 29.8% of men with iCMP died.
“Importantly, our study showed a lower death rate in women with HF due to iCMP than other etiologies,” says Dr. Mansur. The main predictors of death for all patients were chronic kidney disease (CKD), diabetes, stroke, age, lower baseline LVEF, myocardial infarction (MI), device implantation, and revascularization (Table). The main death predictors for niCMP for all patients and men were CKD, diabetes, stroke, atrial fibrillation (AF), age, lower baseline LVEF, device implantation, and idiopathic cardiomyopathies, whereas the main mortality predictors for women were CKD, diabetes, stroke, AF, age, and lower baseline LVEF. The main predictors of death in all patients were CKD, stroke, diabetes, AF, MI, myocardial revascularization, age, and LVEF baseline. Stroke, CKD, diabetes, AF, myocardial revascularization, MI, and age in women, and CKD, diabetes, stroke, AF, MI, age and LVEF baseline in men were the main predictors of death for iCMP.
“Our research sheds light on notable distinctions in clinical characteristics between male and female patients,” Dr. Mansur says. “However, gender itself was not an independent predictor of all-cause mortality in either iCMP or niCMP. Our study underscores the influential role of other critical factors, especially the number and type of comorbidities, which are mostly similar for women and men. These include CKD, stroke, diabetes, AF, age, and previous MI.”
In light of these results, HF patients with diabetes represent a subgroup in which clinicians should still consider using lipid-lowering therapies, such as statins. However, additional research is needed to explore whether statins should be the standard of care in patients with HF without diabetes. “We need better clarity on the role of LDL-C in HF so that we can prescribe lipidlowering therapy more safely in this growing patient population,” Dr. Gouveia says.
Forging More Effective Strategies to Manage HF
The novel insights from this study may help propel the medical community toward more relevant and effective strategies for managing HF and promoting better health outcomes. “The main implication of our study is that treatment of HF in iCMP and niCMP must be similar in women and men, with particular attention being paid to those with various comorbidities,” Dr. Mansur says. According to Dr. Mansur, future research should focus on long-term follow-up studies and address interactions with comorbidities. “Efforts are also needed to develop tailored approaches using biomarkers and to analyze the impact of gender on quality of life and functional status,” he says. “In addition, studies should assess healthcare access and sex-disparities in the treatment and outcomes of HF. Furthermore, advanced machine learning techniques may be used to develop predictive models that consider gender-specific factors to estimate death risk in HF patients.”
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