Risk of death from heart failure is lower in women than in men
Women with chronic heart failure survive longer than their male counterparts, according to a large analysis of studies comprising data on more than 40,000 subjects.(1) The analysis represents the largest assessment of gender and mortality risk in heart failure - and provides evidence which many randomised trials have failed to do because they have been dominated by male patients.
Heart failure is by far the single biggest reason for acute hospital admission. Its incidence is still increasing: more cases are being identified, more people are living to an old age, and more are surviving a heart attack but with damage to the heart muscle. The condition arises when the heart fails to pump sufficient blood to meet the body’s demands. The common symptoms of heart failure - shortness of breath, tiredness, oedema - are usually associated with failure of the left side of the heart (the left ventricle, which pumps blood into the circulation), as defined by a measurement known as left ventricular ejection fraction.
The latest study, published on the 8th of March in the European Journal of Heart Failure, also found that heart failure patients whose ejection fraction is not reduced (i.e., is “preserved”) have a lower mortality risk that those with reduced ejection fraction. Preserved ejection fraction is more common among women than men, and this, say the authors, “may be expected to lead to better survival for these patients”.
The study, known as the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC), analysed data from 31 randomised and observational studies involving 28,052 men and 13,897 women with chronic heart failure. The data were analysed for survival over three years of follow-up, and showed that 25.3% of the women and 25.7% of the men died during the three years; this represented a death rate of 137 deaths per 1000 patient-years in men and 135 per 100 patient-years in women.
When adjusted for age, however, the results showed that men had a 31% higher risk of death than women (hazard ratio 1.31, with statistically significant confidence intervals), and that male gender was an independent risk factor for death at three years (hazard ratio 1.23). The study, say the authors, was “appropriately powered to ascertain the prognostic significance of sex in patients with heart failure”.
This excess mortality risk associated with male gender was of similar magnitude in patients with either reduced or preserved ejection fraction, which was not affected by either age or history of hypertension.
Heart Disease Risk In Women
If you are a woman, it is important to understand your heart disease risk - and to do something about it.
While many women (and unfortunately, many doctors) apparently still do not know it, heart disease is the number one killer of women. About a half million women die of heart disease each year in the U.S. - in fact, more women than men die from cardiovascular disease. Just as bad, women have significantly more strokes than men. So, to keep your chances of developing heart disease and stroke as low as possible, it is extremely important for you to control your risk factors.
So which heart disease and stroke risk factors do you need to be concerned about as a woman? Which can you control? Let’s take a look.
Other results from the study showed that women with chronic heart failure are on average older than men, are more likely to have a history of hypertension and diabetes, but that their heart failure is less likely to be caused by heart failure of ischaemic origin (reduced blood supply).
Heart Attack Risk Differs Between Men and Women
Findings on coronary CT angiography (CTA), a noninvasive test to assess the coronary arteries for blockages, show different risk scenarios for men and women, according to a study presented November 30 at the Radiological Society of North America (RSNA).
Coronary artery disease (CAD) is a narrowing of the blood vessels that supply blood and oxygen to the heart. It is caused by a build-up of fat and other substances that form plaque on vessel walls. According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death for both men and women in the U.S.
Researchers at the Medical University of South Carolina analyzed the results of coronary CTA on 480 patients, mean age 55, with acute chest pain. Approximately 65 percent of the patients were women, and 35 percent were men. The possibility of acute coronary syndrome was ruled out for each of the patients.
Using coronary CTA, the researchers were able to determine the number of vessel segments with plaque, the severity of the blockage and the composition of the plaque.
“The latest CT scanners are able to produce images that allow us to determine whether the plaque is calcified, non-calcified or mixed,” said John W. Nance Jr., M.D., currently a radiology resident at Johns Hopkins Hospital in Baltimore, Md.
By comparing the coronary CTA results with outcome data over a 12.8-month follow-up period, the researchers were able to correlate the extent, severity and type of plaque build-up with the occurrence of major adverse cardiac events, such as a heart attack or coronary bypass surgery. The statistical analysis tested all plaques combined (calcified, non-calcified and mixed) and each individual plaque type separately.
“This study has clearly demonstrated that survival is better for women with heart failure than for men, irrespective of ejection fraction, age or other variables,” said first author Dr Manuel Martinez-Selles from the Gregorio Marañón University Hospital in Madrid.