GENDER DIFFERENCES IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND HEART FAILURE WITH REDUCED EJECTION FRACTION: ARE AGE, HYPERTENSION AND ATRIAL FIBRILLATION THE ANSWER?

Abstract

Objective: Gender differences may exist in heart failure with reduced ejection fraction (HFrEF) patients, but little research has been conducted on this topic so far, mainly because women are underrepresented in clinical trials. The addition of type 2 diabetes mellitus (T2DM) to HFrEF might have an influence on gender differences as well. Our objective was to evaluate and report gender differences in a group of patients with HFrEF and T2DM. Design and method: Observational, retrospective study using the medical records of patients with HFrEF and T2DM hospitalized in the Internal Medicine Department of an emergency referral hospital in Romania between January-June 2017. Results: The study group (70.81 ± 9.49 years, range 38–92 years) included 100 patients with HFrEF and T2DM: 47 women (47.00%, 73.02 ± 8.47 years, range 57–92 years), 53 men (53.00%, 68.85 ± 9.90 years, range 38–86 years). NYHA class: 63 (63.00%) patients NYHA class II, 18 (18.00%) patients NYHA class III and 19 (19.00%) patients NYHA class IV. Women with HFrEF and T2DM were older (p = 0.0283) and were more likely to be hypertensive (p = 0.002) vs. men with HFrEF and T2DM who were more likely to have atrial fibrillation (p = 0.05) vs. women. NYHA class II was the most frequent functional class in both genders (61.70% in women vs. 64.15% in men). NYHA class III was more common in men vs. women (22.64% vs. 12.77%), whereas NYHA class IV was more common in women vs. men (25.51% vs. 13.21%). Women with HFrEF and T2DM were more likely to have hypertension, dyslipidemia, obesity, anemia, nephropathy, dyselectrolytemia, neuropathy or retinopathy vs. men. As compared to women, men with HFrEF and T2DM were more likely to be diagnosed with valvulopathy, coronary heart disease, atrial fibrillation, chronic kidney disease, hepatic steatosis, chronic venous insufficiency or peripheral arterial disease. Conclusions: Our study reinforces that gender differences in HFrEF and T2DM patients exist: women were more likely to be older, have a more severe NYHA functional class or suffer from hypertension, obesity, dyslipidemia, microvascular complications and dyselectrolytemia. Men with HFrEF and T2DM were younger, had a less severe NYHA functional class and often had more macrovascular complications.