Journal
EUROPEAN HEART JOURNAL
Volume 34, Issue 32, Pages 2538-+Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/eht152
Keywords
Heart failure; Sex; Biomarkers; Aetiology; Mortality
Categories
Funding
- Netherlands Heart Foundation [2000Z003]
- Biosite France SAS, Jouy-en-Josas, France
- Roche Diagnostics Nederland BV, Venlo, the Netherlands
- Novartis PharmaBV, Arnhem, the Netherlands
- Dutch Heart Foundation [2006T37]
- European Commission [FP7-242209-BIOSTAT-CHF]
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Despite disparities in pathophysiology and disease manifestation between male and female patients with heart failure, studies focusing on sex differences in biomarkers are scarce. The purpose of this study was to assess sex-specific variation in clinical characteristics and biomarker levels to gain more understanding of the potential pathophysiological mechanisms underlying sex differences in heart failure. Baseline demographic and clinical characteristics, multiple biomarkers, and outcomes were compared between men and women in 567 patients. The mean age of the study group was 71 11 years and 38 were female. Women were older, had a higher body mass index and left ventricular ejection fraction, more hypertension, and received more diuretic and antidepressant therapy, but less ACE-inhibitor therapy compared with men. After 3 years, all-cause mortality was lower in women than men (37.0 vs. 43.9, multivariable hazard ratio 0.64; 95 confidence interval 0.450.92, P 0.016). Levels of biomarkers related to inflammation [C-reactive protein, pentraxin 3, growth differentiation factor 15 (GDF-15), and interleukin 6] and extracellular matrix remodelling (syndecan-1 and periostin) were significantly lower in women compared with men. N-terminal pro-brain natriuretic peptide, TNF-R1a, and GDF-15 showed the strongest interaction between sex and mortality. Female heart failure patients have a distinct clinical presentation and better outcomes compared with male patients. The lower mortality was independent of differences in clinical characteristics, but differential sex associations between several biomarkers and mortality might partly explain the survival difference.
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