Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes

Regitz‐Zagrosek, Vera; Oertelt‐Prigione, Sabine; Prescott, Eva; Franconi, Flavia; Gerdts, Eva; Foryst‐Ludwig, Anna; Maas, Angela H.E.M.; Kautzky‐Willer, Alexandra; Knappe-Wegner, Dorit; Kintscher, Ulrich; Ladwig, Karl Heinz; Schenck‐Gustafsson, Karin; Stangl, Verena

doi:10.1093/eurheartj/ehv598

Cited by 535 publications

(275 citation statements)

References 181 publications

(143 reference statements)

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“…Although not supported by the pivotal trials, a meta‐analysis including 7 trials of NOACs concluded that women have a higher bleeding risk than men in acute venous thromboembolism treated by NOAC 20. Possible mechanisms include differences in creatinine clearance, volume distribution, and drug uptake between men and women 21. Our finding suggests a need for future investigations (preferably randomized) of sex‐related differences in bleeding between OAC drugs.…”

Section: Discussionmentioning

confidence: 71%

Major Bleeding Complications and Persistence With Oral Anticoagulation in Non‐Valvular Atrial Fibrillation: Contemporary Findings in Real‐Life Danish Patients

Lamberts

Stærk

Olesen

et al. 2017

JAHA

122

121

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BackgroundThe nonvitamin K antagonist oral anticoagulants have recently become available as an alternative to warfarin as stroke prophylaxis in atrial fibrillation, but data on real‐life patient experience, including bleeding risk, are lacking. Our objective was to compare major bleeding events and nonpersistence between the nonvitamin K antagonist oral anticoagulant apixaban and other nonvitamin K antagonist oral anticoagulants (dabigatran and rivaroxaban) and warfarin in a contemporary, nation‐wide cohort of patients with nonvalvular atrial fibrillation.Methods and ResultsOf 54 321 patients (median age, 73 years; 56% male; mean CHA 2 DS 2‐VASc score, 2.9), 7963, 6715, 15 413, and 24 230 patients initiated apixaban, rivaroxaban, dabigatran, and warfarin, respectively. Apixaban and rivaroxaban initiators were older, less often male, with higher HAS‐BLED and CHA 2 DS 2‐VASc scores compared with dabigatran and warfarin initiators. A total of 2418 patients (4.5%) experienced a major bleeding event over all available follow‐up. In this period, rivaroxaban (hazard ratio [HR] [95% CI], 1.49 [1.27–1.77]), dabigatran (HR, 1.17 [1.00–1.38]), and warfarin (HR, 1.23 [1.05–1.43]) users were significantly more likely to bleed than apixaban users. Findings were similar when restricted to the first 30 days after OAC initiation. Risk of nonpersistence was higher for dabigatran (HR, 1.45 [1.33–1.59]) and warfarin initiators (HR, 1.22 [1.12–1.33]), but not for rivaroxaban initiators (HR, 1.07 [0.96–1.20]) compared with apixaban initiators.ConclusionsIn a real‐world cohort of nonvalvular atrial fibrillation patients, apixaban had a lower adjusted major bleeding risk compared with rivaroxaban, dabigatran, and warfarin. Apixaban had a lower risk of nonpersistence compared with dabigatran and warfarin and similar risk compared with rivaroxaban.

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Section: Discussionmentioning

confidence: 71%

Major Bleeding Complications and Persistence With Oral Anticoagulation in Non‐Valvular Atrial Fibrillation: Contemporary Findings in Real‐Life Danish Patients

Lamberts

Stærk

Olesen

et al. 2017

JAHA

122

121

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“…Cardiac societies from both sides of the Atlantic have released specific documents on sex differences in presentation, treatment, and outcomes of cardiovascular disease,2, 31 though prospective studies aimed at investigating the reasons for the persisting worse outcomes of STEMI in women are still lacking 32…”

Section: Discussionmentioning

confidence: 99%

Contemporary Trends and Age‐Specific Sex Differences in Management and Outcome for Patients With ST‐Segment Elevation Myocardial Infarction

Luca¹,

Marini

Gonzini

et al. 2016

JAHA

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BackgroundAge‐ and sex‐specific differences exist in the treatment and outcome of ST‐elevation myocardial infarction (STEMI). We sought to describe age‐ and sex‐matched contemporary trends of in‐hospital management and outcome of patients with STEMI.Methods and ResultsWe analyzed data from 5 Italian nationwide prospective registries, conducted between 2001 and 2014, including consecutive patients with STEMI. All the analyses were age‐ and sex‐matched, considering 4 age classes: <55, 55 to 64, 65 to 74, and ≥75 years. A total of 13 235 patients were classified as having STEMI (72.1% men and 27.9% women). A progressive shift from thrombolysis to primary percutaneous coronary intervention occurred over time, with a concomitant increase in overall reperfusion rates (P for trend <0.0001), which was consistent across sex and age classes. The crude rates of in‐hospital death were 3.2% in men and 8.4% in women (P<0.0001), with a significant increase over age classes for both sexes and a significant decrease over time for both sexes (all P for trend <0.01). On multivariable analysis, age (odds ratio 1.09, 95% CI 1.07–1.10, P<0.0001) and female sex (odds ratio 1.44, 95% CI 1.07–1.93, P=0.009) were found to be significantly associated with in‐hospital mortality after adjustment for other risk factors, but no significant interaction between these 2 variables was observed (P for interaction=0.61).ConclusionsDespite a nationwide shift from thrombolytic therapy to primary percutaneous coronary intervention for STEMI affecting both sexes and all ages, women continue to experience higher in‐hospital mortality than men, irrespective of age.

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Section: Introductionmentioning

confidence: 99%

“…Noteworthy are the differences between women and men in younger age groups (18 and 29 years), showing a prevalence of 1.3% in women and 8.5% in men and 7.3% in women vs. 15.8% in men in people at the age of 30-44 years. No major sex differences in clinical manifestations of HT outside of pregnancy-related HT have been described [1][2][3][4][5].According to current clinical practice guidelines, no differences between men and women have been documented regarding diagnostic approaches for HT. As far as the differences between genders in hypertensive patients are concerned, female sex stands among the factors associated with a higher prevalence of white coat HT, whereas male sex is related to increased prevalence of masked HT [1][2][3][4][5].…”

mentioning

confidence: 99%

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Relationship between gender and clinical characteristics, associated factors, and hypertension treatment in patients with resistant hypertension

Prejbisz¹,

Gąsowski²,

Klocek³

et al. 2017

Kardiol Pol

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A b s t r a c tBackground and aim: Recent meta-analyses indicate that the pooled prevalence of resistant hypertension (RHT) barely differs between the sexes. However, differences between women and men with RHT in patient characteristics, associated factors, and hypertension (HT) management are still not well-described. Methods:In the cross-sectional questionnaire-based observational study we included 7306 hypertensive females and 5069 hypertensive males, ≥ 18 years old, and treated for at least 12 months with antihypertensive drugs. We defined HT control as blood pressure (BP) levels both < 140 mm Hg/< 90 mm Hg. Patients were divided into three groups: controlled HT, uncontrolled HT (not fulfilling the criteria of RHT), and RHT (uncontrolled HT despite using three antihypertensive drugs including diuretic). Cardiovascular (CV) risk was evaluated according to 2013 ESH/ESC guidelines.Results: There were no differences in the rates of controlled HT (47.6% vs. 47.0%), uncontrolled HT (27.3% vs. 28.8%), and RHT (25.1% vs. 24.2%) between women and men, respectively (p = 0.17). Among patients with RHT, women were older than men and had lower diastolic BP and estimated glomerular filtration rate (eGFR) as well as higher pulse pressure (PP). Cerebrovascular diseases (16.9% vs. 14.3%; p = 0.062), abdominal obesity, and metabolic syndrome (MS, 70.5% vs. 60.1%; p < 0.001) were more frequent among women than men with RHT. Women with RHT had higher rate of high/very high added CV risk in comparison to men. In a multivariate model higher PP, presence of MS, CV disease, and eGFR < 60 mL/min/1.73 m 2 were related to the presence of RHT both in males and females. In women RHT was also related to abdominal obesity, cerebrovascular diseases, and diseases causing disability. In men, RHT was additionally related to diseases requiring treatment with non-steroidal anti-inflammatory drugs. Conclusions:Although there were no differences in the rate of RHT between women and men, we identified gender-related differences in CV risk profiles in RHT patients and in factors related with the presence of RHT. When divided into age groups, RHT was less frequent in women aged less than 40 years and aged between 40 and 65 years, and among patients 65 years and older there was a tendency towards a higher rate of HT in women. 422 INTRODUCTIONHypertension (HT) is more common in women than in men in ageing populations. In Europe and the United States, one in three adults presents with arterial hypertension. Noteworthy are the differences between women and men in younger age groups (18 and 29 years), showing a prevalence of 1.3% in women and 8.5% in men and 7.3% in women vs. 15.8% in men in people at the age of 30-44 years. No major sex differences in clinical manifestations of HT outside of pregnancy-related HT have been described [1][2][3][4][5].According to current clinical practice guidelines, no differences between men and women have been documented regarding diagnostic approaches for HT. As far as the differences between genders in hypertensive ...

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Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes

Cited by 535 publications

References 181 publications

Major Bleeding Complications and Persistence With Oral Anticoagulation in Non‐Valvular Atrial Fibrillation: Contemporary Findings in Real‐Life Danish Patients

Major Bleeding Complications and Persistence With Oral Anticoagulation in Non‐Valvular Atrial Fibrillation: Contemporary Findings in Real‐Life Danish Patients

Contemporary Trends and Age‐Specific Sex Differences in Management and Outcome for Patients With ST‐Segment Elevation Myocardial Infarction

Relationship between gender and clinical characteristics, associated factors, and hypertension treatment in patients with resistant hypertension

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