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(Ivanhoe Newswire) Going way beyond Mars and Venus, the differences between men and women in their risk for developing heart failure (HF) and their prognosis are striking.
Men and women may also respond differently to treatment, raising serious concerns about current practices and reinforcing the urgency for gender-specific clinical trials, according to a review article.
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In the last decade, major multicenter HF trials on average included only 28 percent women.
"Current practice is to treat heart failure similarly in men and women," Eileen Hsich, M.D., director of the Women's Heart Failure Clinic at the Cleveland Clinic in Ohio was quoted as saying. "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 HFa life-threatening condition in which the heart cannot pump enough blood throughout the bodyaffects 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."
There is evidence that gender-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 compared to men, yet the cut-off values to determine the need for a heart transplant 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 in 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. She emphasized that these finding should in no way prompt women to deviate from their doctors recommendations.
"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 gender-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., "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."
SOURCE: Journal of the American College of Cardiology, August 4, 2009
If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Melissa Medalie at mmedalie@ivanhoe.com
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