Abstract
Despite disparities in pathophysiology and disease manifestation between male and female patients with heart failure, studies focusing on sex differences in biomarkers are scarce. The purpose of this study was to assess sex-specific variation in clinical characteristics and biomarker levels to gain more understanding of the potential pathophysiological mechanisms underlying sex differences in heart failure. Baseline demographic and clinical characteristics, multiple biomarkers, and outcomes were compared between men and women in 567 patients. The mean age of the study group was 71 ± 11 years and 38% were female. Women were older, had a higher body mass index and left ventricular ejection fraction, more hypertension, and received more diuretic and antidepressant therapy, but less ACE-inhibitor therapy compared with men. After 3 years, all-cause mortality was lower in women than men (37.0 vs. 43.9%, multivariable hazard ratio = 0.64; 95% confidence interval 0.45-0.92, P = 0.016). Levels of biomarkers related to inflammation [C-reactive protein, pentraxin 3, growth differentiation factor 15 (GDF-15), and interleukin 6] and extracellular matrix remodelling (syndecan-1 and periostin) were significantly lower in women compared with men. N-terminal pro-brain natriuretic peptide, TNF-αR1a, and GDF-15 showed the strongest interaction between sex and mortality. Female heart failure patients have a distinct clinical presentation and better outcomes compared with male patients. The lower mortality was independent of differences in clinical characteristics, but differential sex associations between several biomarkers and mortality might partly explain the survival difference.
Highlights
Heart failure (HF) is a clinical syndrome that affects both men and women
The duration of heart failure, NYHA functional class and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) score did not differ between sexes
Hypertension and diabetes were more common in women, while chronic obstructive pulmonary disease was more prevalent in men
Summary
Heart failure (HF) is a clinical syndrome that affects both men and women. The total number of men and women living with heart failure is similar,[1] female patients are underrepresented in clinical studies in heart failure.[2,3] evidence relating to pathophysiology, aetiology, clinical presentation, treatment, and outcome is predominantly based on data from male patients.[4] A few major pharmacological and device trials in heart failure patients have performed sex-specific analyses. In contrast to patients with cardiovascular disease, these trials consistently reported an independent survival benefit for women.[5,6,7,8] Sex-specific analysis of the Candesartan in
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