Abstract
BackgroundWe aimed to clarify the sex differences in various cardiovascular and non-cardiovascular outcomes, and to investigate whether sex differences in outcomes are affected by age in hypertrophic cardiomyopathy (HCM).MethodsA cohort of 835 patients with HCM initially evaluated during 2007–2019 were followed for a median of 6.4 years. Study outcomes were all-cause death, cardiovascular and non-cardiovascular death, sudden cardiac death (SCD)/SCD equivalent events, heart failure (HF) events, and the composite cardiovascular outcome including cardiovascular death, SCD/SCD equivalent events, admission for HF, and heart transplantation.ResultsWomen were 5 years older (women 59.9±13.5 vs. men 54.9±11.4 years), had worse dyspnea, and greater left ventricular (LV) diastolic dysfunction and obstructive physiology at presentation. Women compared to men had higher all-cause mortality and cardiovascular event rates, driven by more cardiovascular deaths and heart failure (HF) events. Conversely, non-cardiovascular mortality was not different between the sexes. Female sex was independently associated with all-cause death (HR 1.88, 95% CI 1.11–3.20) and composite cardiovascular events (HR 3.60, 95% CI 2.00–6.49), independent of age, body mass index, New York Heart Association class, SCD risk score, and LV ejection fraction. When stratified by the age of 60, sex differences were not significant at <60 years; however, at ≥60 years, women had worse LV diastolic function, greater obstructive physiology, as well as worse survival and composite cardiovascular outcomes. Sex differences in outcomes remained consistent after propensity score matching for age and other clinical characteristics.ConclusionsWomen with HCM have worse cardiovascular prognosis than men, driven by higher cardiovascular mortality and HF events. The negative impact of female sex on cardiac function and cardiovascular outcome became prominent at age ≥60 years, suggesting age-related sex differences in the prognosis of HCM.
Highlights
Women compared to men had higher all-cause mortality and cardiovascular event rates, driven by more cardiovascular deaths and heart failure (HF) events
Female sex was independently associated with all-cause death (HR 1.88, 95% confidence interval (CI) 1.11–3.20) and composite cardiovascular events (HR 3.60, 95% CI 2.00–6.49), independent of age, body mass index, New York Heart Association class, sudden cardiac death (SCD) risk score, and left ventricular (LV) ejection fraction
The negative impact of female sex on cardiac function and cardiovascular outcome became prominent at age 60 years, suggesting age-related sex differences in the prognosis of Hypertrophic cardiomyopathy (HCM)
Summary
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy with an autosomal dominant trait [1]; clinical features have been reported to vary according to sex in large cohort studies. The prevalence of HCM is higher in men [2, 3]. Data regarding clinical outcomes are conflicting with some studies reporting no sex differences in overall mortality [4, 7], and others reporting that women have worse survival than men in HCM [5, 10]. Most studies consistently report a higher risk of heart failure (HF) progression in women [4, 7, 8, 10]. Representative age-related cardiac remodeling involves increasing LV wall thickness in a concentric pattern, and there are sex-specific differences in this process which may affect sex differences in patients with HCM; there is a paucity of data. Conflicting reports mentioned above regarding sex differences in the clinical outcomes of HCM patients may be related to the different age distributions. Aging-related issues are clinically important, given the extended longevity of patients with HCM caused by recent advances in the contemporary management of HCM [11]
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