Gender differences in pharmacotherapy of chronic heart failure
Authors:
A. Klabník 1; J. Murín 2
Authors‘ workplace:
Kardiologické oddelenie Stredoslovenského ústavu srdcových a cievnych chorôb, Banská Bystrica, Slovenská republika, prednosta prim. MU Dr. Peter Mečiar
1; I. interná klinika Lekárskej fakulty Univerzity Komenského a FNsP Bratislava, Slovenská republika, prednostka doc. MU Dr. Soňa Kiňová, PhD.
2
Published in:
Vnitř Lék 2009; 55(12): 1167-1172
Category:
Reviews
Overview
At this point, guidelines recommend the same care for patients with chronic heart failure (HF), regardless of gender. In the future, however, HF care may need to be tailored by sex, as the best way to optimize outcomes for both men and women. Because prior studies demonstrated sex‑related differences in many aspects of HF care (in the appropriate use and dosing of evidence‑based therapy and in the individual response to pharmacological treatment between women and men with HF). In general, benefit of beta‑blockers, ACE inhibitors, angiotensin II receptor blockers (ARBs) and spironolactone in clinical trials was similar, regardless of gender. Women with HF appear to have significantly lower mortality rates on ARBs than on the more standard HF therapy (ACE inhibitors), but there was no difference in survival in men prescribed ARBs compared to ACE inhibitors. In a post hoc subgroup analysis digoxin was associated with a increased risk of death from any cause among women with HF, but not men. ACE inhibitor‑induced cough was more frequent among women. The risk of hyperkalemia was increased with male gender in HF patients treated with candesartan. The use of spironolactone was inversely associated with fractures in men with CHF. Previous studies have suggested that female with HF are less likely received guideline- recommended therapies (in appropriate doses). Female patients with HF were less likely to receive certain guideline- recommended evidence‑based treatments, but the influence of patient sex on delivery of these therapies was disappeared when the objective reasons for non‑using of these therapies were taken into account. These sex differences could have potential widespread implications for routine heart failure care.
Key words:
gender – sex – female – women – heart failure
Sources
1. Dickstein K, Cohen‑ Solal A, Filippatos G et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 29: 2388– 2442.
2. Packer M, Bristow MR, Cohn JN et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med 1996; 334: 1349– 1355.
3. Flather MD, Shibata MC, Coats AJ et al. Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 2005; 26: 215– 225.
4. Simon T, Mary‑ Krause M, Funck‑ Brentano C et al. Sex differences in the prognosis of congestive heart failure: results from the Cardiac Insufficiency Bisoprolol Study (CIBIS II). Circulation 2001; 103: 375– 380.
5. Effect of metoprolol CR/ XL in chronic heart failure: Metoprolol CR/ XL Randomised Intervention Trial in Congestive Heart Failure (MERIT‑ HF). Lancet 1999; 353: 2001– 2007.
6. Ghali JK, Piña IL, Gottlieb SS et al. Metoprolol CR/ XL in female patients with heart failure: analysis of the experience in Metoprolol Extended‑ Release Randomized Intervention Trial in Heart Failure (MERIT‑ HF). Circulation 2002; 105: 1585– 1591.
7. Mezu U, Bott‑ Silverman C, Hsich E. Heart failure in women is different than in men; should treatment be different? Cleve Clin J Med 2007; 74: 423– 435.
8. Keyhan G, Chen SF, Pilote L. Angiotensin‑converting enzyme inhibitors and survival in women and men with heart failure. Eur J Heart Fail 2007; 9: 594– 601.
9. Garg R, Yusuf S. Collaborative Group on ACE inhibitor Trials. Overview of randomized trials of angiotensin converting enzyme inhibitors on mortality and morbidity in heart failure. JAMA 1995; 273: 1450– 1456.
10. López‑ Sendón J, Swedberg K, McMurray J et al. Expert consensus document on angiotesin converting enzyme inhibitors in cardiovascular disease. The Task Force on ACE‑inhibitors of the European Society of Cardiology. Eur Heart J 2004; 25: 1454– 1470.
11. Dicpinigaitis PV, Allusson VR, Baldanti A et al. Ethnic and gender differences in cough reflex sensitivity. Respiration 2001; 68: 480– 482.
12. Sadanaga T, Yoshimura M, Sakamoto T et al. Enalapril‑induced cough is associated with non‑severe heart failure. Int J Cardiol 2009; 135: 275– 276.
13. Pitt B, Poole‑ Wilson PA, Segal R et al. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial – the Losartan Heart Failure Survival Study ELITE II. Lancet 2000; 355: 1582– 1587.
14. Majahalme SK, Baruch L, Aknay N et al. Val‑ HeFT Study Investigators. Comparison of treatment benefit and outcome in women versus men with chronic heart failure (from the Valsartan Heart Failure Trial). Am J Cardiol 2005; 95: 529– 532.
15. Desai AS, Swedberg K, McMurray JJ et al. Incidence and predictors of hyperkalemia in patients with heart failure: an analysis of the CHARM program. J Am Coll Cardiol 2007; 50: 1959– 1966.
16. Hudson M, Rahme E, Behlouli H et al. Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure – a population study. Eur J Heart Fail 2007; 9: 602– 609.
17. Ferrario CM, Jessup J, Chappell MC et al. Effect of angiotensin‑converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin‑converting enzyme 2. Circulation 2005; 111: 2605– 2610.
18. Ishiyama Y, Gallagher PE, Averill DB et al. Upregulation of angiotensin‑converting enzyme 2 after myocardial infarction by blockade of angiotensin II receptors. Hypertension 2004; 43: 970– 976.
19. Zisman LS, Keller RS, Weaver B et al. Increased angiotensin‑(1‑ 7)‑ forming activity in failing human heart ventricles: evidence for upregulation of the angiotensin‑converting enzyme homologue ACE2. Circulation 2003; 108: 1707– 1712.
20. Campbell DJ, Zeitz CJ, Esler MD et al. Evidence against a major role for angiotensin converting enzyme‑related carboxypeptidase (ACE2) in angiotensin peptide metabolism in the human coronary circulation. J Hypertens 2004; 22: 1971– 1976.
21. Crackower MA, Sarao R, Oudit GY et al. Angiotensin‑converting enzyme 2 is an essential regulator of heart function. Nature 2002; 417: 822– 828.
22. Strauss MH, Hall A. RAS blockers: does sex matter? Eur J Heart Fail 2007; 9: 963– 964.
23. Rathore SS, Wang Y, Krumholz HM. Sex‑based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med 2002; 347: 1403– 1411.
24. Ahmed A, Rich MW, Love TE et al. Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur Heart J 2006; 27: 178– 186.
25. Ahmed A, Pitt B, Rahimtoola SH et al. Effects of digoxin at low serum concentrations on mortality and hospitalization in heart failure: A propensity- matched study of the DIG trial. Int J Cardiol 2008; 123: 138– 146.
26. Domanski M, Fleg J, Bristow M et al. The effect of gender on outcome in digitalis‑treated heart failure patients. J Card Fail 2005; 11: 83– 86.
27. Blaustein MP, Robinson SW, Gottlieb SS et al. Sex, digitalis, and the sodium pump. Mol Interv 2003; 3: 68– 72.
28. Furberg CD, Vittinghoff E, Davidson M et al. Subgroup interactions in the Heart and Estrogen/ Progestin Replacement Study: lessons learned. Circulation 2002; 105: 917– 922.
29. Wawruch M, Fialova D, Zikavska M et al. Factors influencing the use of potentially inappropriate medication in older patients in Slovakia. J Clin Pharm Ther 2008; 33: 381– 392.
30. Cohen N, Ilgiyaev E, Almoznino- Sarafian D et al. Sex‑related bedside clinical variables associated with survival of older inpatients with heart failure. Eur J Heart Fail 2004; 6: 781– 786.
31. Cohen N, Almoznino‑ Sarafian D, Zaidenstein R et al. Serum magnesium aberrations in furosemide treated patients with congestive heart failure: pathophysiological correlates and prognostic evaluation. Heart 2003; 89: 411– 416.
32. Zenuk C, Healey J, Donnelly J et al. Thiamine deficiency in congestive heart failure patients receiving long term furosemide therapy. Can J Clin Pharmacol 2003; 10: 184– 188.
33. Pitt B, Zannad F, Remme WJ et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study investigators. N Engl J Med 1999; 341: 709– 717.
34. Pitt B, Remme W, Zannad F et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003; 348: 1309– 1321.
35. Weber KT, Carbone LD, Cross JD et al. Fracture risk in men with congestive heart failure risk reduction with spironolactone. J Am Coll Cardiol 2008; 52: 135– 138.
36. Juurlink DN, Mamdani MM, Lee DS et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Eng J Med 2004; 351: 543– 551.
37. Bozkurt B, Agoston I, Knowlton A. Complications of inappropriate use of spironolactone in heart failure: when an old medicine spirals out of new guidelines. J Am Coll Cardiol 2003; 41: 211– 214.
38. Shah KB, Rao K, Sawyer R. The adequacy of laboratory monitoring in patients treated with spironolactone for congestive heart failure. J Am Coll Cardiol 2005; 46: 845– 849.
39. Jochmann N, Stangl K, Garbe E et al. Female‑ specific aspects in the pharmacotherapy of chronic cardiovascular diseases. Eur Heart J 2005; 26: 1585– 1595.
40. Lenzen MJ, Rosengren A, Scholte op Reimer WJ. Management of patients with heart failure in clinical practice: differences between men and women. Heart 2008; 94: e10.
41. Widimský J, Lánska V, Magulová D et al. Průzkum stavu aktuální praxe diagnostiky a léčby srdečního selhání v ordinacích všeobecných lékařů v České a Slovenské republice v roce 1999 (2. část programu IMPROVEMENT of HF). Cor Vasa 2001; 54: 345– 352.
42. Nicol ED, Fittall B, Roughton M et al. NHS heart failure survey: a survey of acute heart failure admissions in England, Wales and Northern Ireland. Heart 2008; 94: 172– 177.
43. Baumhäkel M, Müller U, Böhm M. Influence of gender of physicians and patients on guideline‑ recommended treatment of chronic heart failure in a cross‑ sectional study. Eur J Heart Fail 2009; 11: 299– 303.
44. Rusinaru D, Mahjoub H, Goissen T et al. Clinical features and prognosis of heart failure in women. A 5‑year prospective study. Int J Cardiol 2009; 133: 327– 335.
45. Yancy CW, Fonarow GC, Albert NM et al. Influence of patient age and sex on delivery of guideline‑ recommended heart failure care in the outpatient cardiology practice setting: findings from IMPROVE HF. Am Heart J 2009; 157: 754– 762.
46. Fonarow GC, Abraham WT, Albert NM et al. Age‑ and gender‑related differences in quality of care and outcomes of patients hospitalized with heart failure (from OPTIMIZE‑ HF). Am J Cardiol 2009; 104: 107– 115.
47. Klabník A, Koštek M, Murín J. Sú ženy s chronickým kardiálnym zlyhávaním diskriminované? IV. tatranské kardiologické dni, Štrbské Pleso, 2.– 5. marec 2008 (1. miesto v posterovej sekcii). Cardiol 2008; 17: K/ C54 (Abstrakt).
48. Klabnik A, Kostek M, Murin J. Gender differences in clinical profile, new quality markers and in‑hospital mortality of chronic heart failure. 16th Alpe Adria Cardiology Congress, Portorose, Slovenia, June 5– 7, 2008 (invited lecture). Slovenska Kardiologija 2008; 5 (Suppl 1): 8 (Abstract).
49. Klabnik A, Kostek M, Murin J. Women and chronic heart failure – our initial experiences. Den mladých kardiologů 2008; Hradec Králové, 11. 6. 2008 (lecture). Cor Vasa 2008; 50: K122 (Abstract).
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Internal Medicine
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