New Aspects in Clinical Cardiology: Sex-based Differences in Cardiovascular Morbidity and Mortality

Overview

No relevant sex-based differences in hemodynamic parameters have been described until now but the course of anyheart disease may be modified by factors that act differently in men and women. In a study comparing the incidenceof heart disease and patient survival over the past 50 years, the incidence of heart failure was found to have declinedin women but not in men.With increased sodium excretion and obesity, the hazard ratios for cardiovascular mortalitywere higher in women. A post-hoc subgroup analysis of the DIG study was conducted to assess potential sex-baseddifferences in the effect of digoxin. The authors conclude that digoxin therapy is associated with an increased riskof death in women (P=0.34). The comparison of the effects of digoxin was limited simply to gender only and noother subgroup analyses were preformed although the characteristics of the patients show significant differences inmore than 20 parameters. Hence, the conclusion of these authors can hardly be accepted. Contrary to these partlyconflicting data, the primary results from the Women’s Health Initiative randomized controlled trial focused ondefining the risks and benefits of hormone replacement in postmenopausal women give an unambiguous answer:combined estrogen/progestin therapy should not be initiated or continued for the primary prevention of coronaryheart disease, furthermore, it increases the risks of cardiovascular disease, breast cancer, venous thromboembolismand biliary tract surgery.

Key words:
clinical cardiology, mortality, digoxin, hormone replacement therapy.