Abstract
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.
Highlights
There is a growing interest in sex-related differences in several clinical scenarios
We aim to review those topics and look for sex-related differences in 1-year outcomes after an heart transplant (HT) in an extensive nationwide registry to elucidate possible gaps that may need further investigation in the future
The Spanish Heart Transplant Registry is a prospective database promoted by the Heart Failure Working Group of the Spanish Society of Cardiology, containing detailed clinical information about all HT procedures performed in our country from 1984 to the present
Summary
There is a growing interest in sex-related differences in several clinical scenarios. Women are underrepresented in most clinical trials, and real-life data have shown that they are less often treated with evidence-based therapies and experience adverse drug reactions more often [1]. The reason for these differences between men and women is beyond the scope of the present study. Women have a different clinical profile than men [2]; they develop endstage HF at an older age, have a higher prevalence of HF with preserved ejection fraction and a lower prevalence of ischemic heart disease (IHD) [3,4,5]. Whether the described better outcomes in women with HF may explain this under-representation in advanced heart failure stages has not been explored
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