Women with chronic heart failure survive longer than their male counterparts, according to a large analysis of studies comprising data on more than 40,000 subjects.(1) The analysis represents the largest assessment of gender and mortality risk in heart failure - and provides evidence which many randomised trials have failed to do because they have been dominated by male patients.
Heart failure is by far the single biggest reason for acute hospital admission. Its incidence is still increasing: more cases are being identified, more people are living to an old age, and more are surviving a heart attack but with damage to the heart muscle. The condition arises when the heart fails to pump sufficient blood to meet the body's demands. The common symptoms of heart failure - shortness of breath, tiredness, oedema - are usually associated with failure of the left side of the heart (the left ventricle, which pumps blood into the circulation), as defined by a measurement known as left ventricular ejection fraction.
The latest study, published on the 8th of March in the European Journal of Heart Failure, also found that heart failure patients whose ejection fraction is not reduced (i.e., is "preserved") have a lower mortality risk that those with reduced ejection fraction. Preserved ejection fraction is more common among women than men, and this, say the authors, "may be expected to lead to better survival for these patients".
The study, known as the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC), analysed data from 31 randomised and observational studies involving 28,052 men and 13,897 women with chronic heart failure. The data were analysed for survival over three years of follow-up, and showed that 25.3% of the women and 25.7% of the men died during the three years; this represented a death rate of 137 deaths per 1000 patient-years in men and 135 per 100 patient-years in women.
When adjusted for age, however, the results showed that men had a 31% higher risk of death than women (hazard ratio 1.31, with statistically significant confidence intervals), and that male gender was an independent risk factor for death at three years (hazard ratio 1.23). The study, say the authors, was "appropriately powered to ascertain the prognostic significance of sex in patients with heart failure".
This excess mortality risk associated with male gender was of similar magnitude in patients with either reduced or preserved ejection fraction, which was not affected by either age or history of hypertension.
Other results from the study showed that women with chronic heart failure are on average older than men, are more likely to have a history of hypertension and diabetes, but that their heart failure is less likely to be caused by heart failure of ischaemic origin (reduced blood supply).
"This study has clearly demonstrated that survival is better for women with heart failure than for men, irrespective of ejection fraction, age or other variables," said first author Dr Manuel Martinez-Selles from the Gregorio MaranÞoìn University Hospital in Madrid.
"This survival benefit is inherent to female sex and there are a number of potential explanations for the better outcomes in women. The female heart appears to respond to injury differently from the male heart. For example, women have less ventricular remodelling, greater preservation of right ventricular function, and greater protection against ventricular arrhythmias, neurohormonal activation, genetic mutations, and apoptosis. Some of these advantages could be related to pregnancy and to sex-specific differences in gene expression."
The study also found that overall women were prescribed fewer recommended treatments for heart failure than men - including angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and beta blockers. This under-use in women, say the authors, "was particularly evident in patients with reduced ejection fraction".References
More information on this press release, contact details and a PDF of the paper are available from the ESC's press office.
The European Society of Cardiology (ESC) represents more than 71,200 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.Authors
ESC Press Office | EurekAlert!
New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)
Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology
More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.
Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...
Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.
"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...
The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.
Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...
The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...
Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.
Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...
20.04.2017 | Event News
18.04.2017 | Event News
03.04.2017 | Event News
26.04.2017 | Materials Sciences
26.04.2017 | Agricultural and Forestry Science
26.04.2017 | Physics and Astronomy