Gender and survival in patients with heart failure: interactions with diabetes and aetiology. Results from the MAGGIC individual patient meta‐analysis†

Abstract

AimThe aim of this study was to investigate the relationship between gender and survival of patients with heart failure, using data from both randomized trials and observational studies, and the relative contribution of age, left ventricular systolic function, aetiology, and diabetes to differences in prognosis between men and women. Methods and resultsData from 31 studies (41 949 patients; 28 052 men, 13 897 women) from the Meta-Analysis Global Group In Chronic Heart Failure (MAGGIC) individual patient meta-analysis were used. We performed survival analysis to assess the association of gender with mortality, adjusting for predictors of mortality, including age, reduced or preserved ejection fraction (EF), and ischaemic or non-ischaemic aetiology. Women were older [70.5 ( standard deviation 12.1) vs. 65.6 (standard deviation 11.6) years], more likely to have a history of hypertension (49.9% vs. 40.0%), and less likely to have a history of ischaemic heart disease (46.3% vs. 58.7%) and reduced EF (62.6% vs. 81.6%) compared with men. During 3 years follow-up, 3521 (25%) women and 7232 (26%) men died. After adjustment, male gender was an independent predictor of mortality, and the better prognosis associated with female gender was more marked in patients with heart failure of non-ischaemic, compared with ischaemic, aetiology (P-value for interaction ¼ 0.03) and in patients without, compared with those with, diabetes (P-value for interaction ,0.0001). ConclusionThis large, individual patient data meta-analysis has demonstrated that survival is better for women with heart failure compared with men, irrespective of EF. This survival benefit is slightly more marked in non-ischaemic heart failure but is attenuated by concomitant diabetes.--

Angiotensin 1–7 Ameliorates Diabetic Cardiomyopathy and Diastolic Dysfunction in db/db Mice by Reducing Lipotoxicity and Inflammation

“…2,3 DM and inflammation is often linked to increased prevalence of heart failure and is known to increase the mortality in patients with heart failure with preserved ejection fraction (HFPEF). [4][5][6][7] The myocardial renin-angiotensin system is locally activated, 8 which contributes to the functional abnormalities and increased cardiovascular risk in DM. 9,10 Indeed, elevated angiotensin II (Ang II) levels lead to cardiac hypertrophy, diastolic dysfunction, and cardiac insulin resistance.…”

Is There a Sex Difference in Japanese Patients With Heart Failure?

“…The risk of death is higher in men than in women with heart failure when adjusted for age (hazard ratio (HR) 1.31, 95% confidence interval (CI) 1.25-1.36, P<0.001). (Adopted from Martínez-Sellés et al 6 )…”

“…6 Data from 31 studies (41,949 patients; 28,052 men, 13,897 women) from the MAGGIC showed that women were older (70.5±12.1 vs. 65.6±11.6 years), more likely to have a history of hypertension (49.9% vs. 40.0%), and less likely to have a history of ischemic heart disease (46.3% vs. 58.7%) and reduced EF (62.6% vs. 81.6%) compared with men. During a 3-year follow-up, 3,521 (25%) women and 7,232 (26%) men died, which was comparable.…”

“…After the adjustment for age, male sex was an independent predictor of mortality (Figure), and the better prognosis associated with female sex was more marked in patients with HF of nonischemic etiology, compared with ischemic etiology. 6 HF and preserved EF (HFpEF) constitutes 30-50% of HF patients, and affects women more often than men. Deswal et al evaluated the sex difference in mortality and morbidity for HFpEF (EF >50%) using the ancillary arm of the Digitalis Investigation Group (DIG) trial.…”

Predicting risk after aneurysm surgery – a reply

“….min À1 [1][2][3][4][5][6][7][8][9]. I used a lower hazard ratio of 1.5 for the diagnosis of heart failure because I also incorporated the ventilatory equivalent for carbon dioxide in my calculator, for which I used a hazard ratio of 1.05, rather than 1.07 [10].…”