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Amanda Jekowsky , American College of
Cardiology, 202-375-6645, ajekowsk@acc.org
July
28, 2009
Heart Failure: Women Different than Men
Absence of women in clinical trials hinders development
of tailored
diagnostic cut-offs and treatment
Striking differences in the risk factors for developing heart
failure (HF) and patient prognosis exist between men and women.
Men and women may also respond differently to treatment, raising
concerns about whether current practices provide the best
care and reinforcing the urgency for sex-specific clinical
trials for HF, according to a review article published in
the August 4, 2009, issue of the Journal of the American
College of Cardiology.
“Current practice is to treat heart failure similarly
in men and women,” said Eileen Hsich, M.D., director
of the Women’s Heart Failure Clinic at the Cleveland
Clinic in Ohio. “Yet, our review of published reports
suggests compelling sex differences, not only in terms of
how and when heart failure develops, but also possible responses
to treatments and how the disease impacts quality of life.”
The data show that HF—a life-threatening condition
in which the heart cannot pump enough blood throughout the
body—affects women at an older age and often with a
stronger heart compared to men. Hypertension and valvular
disease are more likely the culprits for HF in women, whereas
men are more likely to have coronary artery disease (CAD)
as the underlying cause. And while women live longer with
the disease, they also tend to have lower quality of life
than men due to greater physical limitations with exercise,
more HF-related hospital stays and depression.
“The reasons why survival is better for women remain
unclear, but it may be due to differences in the underlying
disease,” said Dr. Hsich. “Our findings also raise
questions as to whether certain diagnostic tests or criteria
need to be changed to better reflect how HF presents in female
versus male patients.”
For example, “normal” values for brain natriuretic
peptide—a biomarker that is being used more frequently
to identify patients with symptoms of HF and stratify patients
by risk—are higher for women versus men and abnormal
values with a BNP > 500 pg/ml may be a stronger predictor
of death in women with HF than in men. There is also evidence
that sex-specific differences may result when performing a
cardiopulmonary stress test, which is often used to evaluate
patients for heart transplantation. Women with HF tend to
have a better prognosis for any given peak oxygen consumption
value when compared to men, yet the cut-off values to determine
need for heart transplantation are the same for both sexes.
The potential benefits of certain HF therapies both in terms
of reducing morbidity and mortality appear to be different
among women.
“We found that some of the available medications may
not be as effective in women, while other therapies, for example,
beta blockers, aldosterone antagonists and pacemakers, may
be very beneficial,” said Dr. Hsich, although she cautions
that these finding should in no way prompt women to deviate
from what their doctor recommends.
“We need to remember that the therapy women are receiving
must be working because they are living longer,” she
added. “Still, we need to gain a better understanding
of HF in women so that we know whether we are providing the
best possible care.”
A critical challenge remains enrolling women in clinical
trials and inspiring researchers to conduct sex-specific studies.
“This is a disease that affects women just as much
as men, yet it remains poorly understood and women are still
underrepresented in studies,” said Dr. Hsich, adding
that major multicenter HF trials in the last decade on average
only included 28 percent women. “It is really important
for women to speak up and not wait for their doctor to approach
them about participating in a clinical trial. In doing so,
we can help ensure that future advances in HF treatments are
applicable to women and supported by sound research.”
Approximately 2.7 million women have HF, which accounts for
35 percent of the total female cardiovascular mortality.
Dr. Hsich and co-author, Ileana Pina, M.D., Case Western
Reserve University, performed a systematic review of the literature
and also contacted the lead investigators of the major CV
trials to request sex-specific data if it was not provided
in their original publication.
Dr. Hsich reports no conflicts of interest.
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cardiovascular care and disease prevention. The College is
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The American College of Cardiology (ACC) provides these news
reports of clinical studies published in the Journal of
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