Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure - Results of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program

Eileen O'Meara, Tim Clayton, Margaret B. McEntegart, John J V McMurray, Ileana L. Pina, Christopher B. Granger, Jan Östergren, Eric L. Michelson, Scott D. Solomon, Stuart Pocock, Salim Yusuf, Karl Swedberg, Marc A. Pfeffer

Research output: Contribution to journalArticle

143 Citations (Scopus)

Abstract

BACKGROUND - We wished to test previous hypotheses that sex-related differences in mortality and morbidity may be due to differences in the cause of heart failure or in left ventricular ejection fraction (LVEF) by comparing fatal and nonfatal outcomes in women and men with heart failure and a broad spectrum of left ventricular ejection fraction. METHODS AND RESULTS - We compared outcomes in 2400 women and 5199 men randomized in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program using multivariable regression analyses. A total of 1188 women (50%) had a low LVEF (≤0.40), and 1212 had a preserved LVEF (>0.40). Among the men, 3388 (65%) had a low LVEF, and 1811 had a preserved LVEF. A total of 1216 women (51%) and 3465 men (67%) had an ischemic cause of their heart failure. All-cause mortality was 21.5% in women and 25.3% in men (adjusted hazard ratio [HR], 0.77; 95% CI, 0.69 to 0.86; P<0.001). Fewer women (30.4%) than men (33.3%) experienced cardiovascular death or heart failure hospitalization (adjusted HR, 0.83; 95% CI, 0.76 to 0.91; P<0.001). The risks of sudden death (HR, 0.70; 95% CI, 0.58 to 0.85) and death due to worsening heart failure (HR, 0.72; 95% CI, 0.58 to 0.89) were reduced to a comparable extent. The adjusted risk of cardiovascular hospitalization was also lower in women (HR, 0.88; 95% CI, 0.82 to 0.95), mainly because of a reduced risk of heart failure hospitalization (HR, 0.87; 95% CI, 0.78 to 0.97). Women had a lower risk of death irrespective of cause of heart failure or LVEF. CONCLUSIONS - Among patients with heart failure, women have lower risks of most fatal and nonfatal outcomes that are not explained, as previously suggested, by LVEF or origin of the heart failure.

Original languageEnglish (US)
Pages (from-to)3111-3120
Number of pages10
JournalCirculation
Volume115
Issue number24
DOIs
StatePublished - Jun 2007
Externally publishedYes

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Sex Characteristics
Heart Failure
Stroke Volume
Morbidity
Mortality
Hospitalization
Fatal Outcome
candesartan
Sudden Death
Cause of Death
Regression Analysis

Keywords

  • Etiology
  • Heart failure
  • Mortality
  • Sex

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure - Results of the Candesartan in Heart failure : Assessment of Reduction in Mortality and morbidity (CHARM) program. / O'Meara, Eileen; Clayton, Tim; McEntegart, Margaret B.; McMurray, John J V; Pina, Ileana L.; Granger, Christopher B.; Östergren, Jan; Michelson, Eric L.; Solomon, Scott D.; Pocock, Stuart; Yusuf, Salim; Swedberg, Karl; Pfeffer, Marc A.

In: Circulation, Vol. 115, No. 24, 06.2007, p. 3111-3120.

Research output: Contribution to journalArticle

O'Meara, E, Clayton, T, McEntegart, MB, McMurray, JJV, Pina, IL, Granger, CB, Östergren, J, Michelson, EL, Solomon, SD, Pocock, S, Yusuf, S, Swedberg, K & Pfeffer, MA 2007, 'Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure - Results of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program', Circulation, vol. 115, no. 24, pp. 3111-3120. https://doi.org/10.1161/CIRCULATIONAHA.106.673442
O'Meara, Eileen ; Clayton, Tim ; McEntegart, Margaret B. ; McMurray, John J V ; Pina, Ileana L. ; Granger, Christopher B. ; Östergren, Jan ; Michelson, Eric L. ; Solomon, Scott D. ; Pocock, Stuart ; Yusuf, Salim ; Swedberg, Karl ; Pfeffer, Marc A. / Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure - Results of the Candesartan in Heart failure : Assessment of Reduction in Mortality and morbidity (CHARM) program. In: Circulation. 2007 ; Vol. 115, No. 24. pp. 3111-3120.
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abstract = "BACKGROUND - We wished to test previous hypotheses that sex-related differences in mortality and morbidity may be due to differences in the cause of heart failure or in left ventricular ejection fraction (LVEF) by comparing fatal and nonfatal outcomes in women and men with heart failure and a broad spectrum of left ventricular ejection fraction. METHODS AND RESULTS - We compared outcomes in 2400 women and 5199 men randomized in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program using multivariable regression analyses. A total of 1188 women (50{\%}) had a low LVEF (≤0.40), and 1212 had a preserved LVEF (>0.40). Among the men, 3388 (65{\%}) had a low LVEF, and 1811 had a preserved LVEF. A total of 1216 women (51{\%}) and 3465 men (67{\%}) had an ischemic cause of their heart failure. All-cause mortality was 21.5{\%} in women and 25.3{\%} in men (adjusted hazard ratio [HR], 0.77; 95{\%} CI, 0.69 to 0.86; P<0.001). Fewer women (30.4{\%}) than men (33.3{\%}) experienced cardiovascular death or heart failure hospitalization (adjusted HR, 0.83; 95{\%} CI, 0.76 to 0.91; P<0.001). The risks of sudden death (HR, 0.70; 95{\%} CI, 0.58 to 0.85) and death due to worsening heart failure (HR, 0.72; 95{\%} CI, 0.58 to 0.89) were reduced to a comparable extent. The adjusted risk of cardiovascular hospitalization was also lower in women (HR, 0.88; 95{\%} CI, 0.82 to 0.95), mainly because of a reduced risk of heart failure hospitalization (HR, 0.87; 95{\%} CI, 0.78 to 0.97). Women had a lower risk of death irrespective of cause of heart failure or LVEF. CONCLUSIONS - Among patients with heart failure, women have lower risks of most fatal and nonfatal outcomes that are not explained, as previously suggested, by LVEF or origin of the heart failure.",
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T1 - Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure - Results of the Candesartan in Heart failure

T2 - Assessment of Reduction in Mortality and morbidity (CHARM) program

AU - O'Meara, Eileen

AU - Clayton, Tim

AU - McEntegart, Margaret B.

AU - McMurray, John J V

AU - Pina, Ileana L.

AU - Granger, Christopher B.

AU - Östergren, Jan

AU - Michelson, Eric L.

AU - Solomon, Scott D.

AU - Pocock, Stuart

AU - Yusuf, Salim

AU - Swedberg, Karl

AU - Pfeffer, Marc A.

PY - 2007/6

Y1 - 2007/6

N2 - BACKGROUND - We wished to test previous hypotheses that sex-related differences in mortality and morbidity may be due to differences in the cause of heart failure or in left ventricular ejection fraction (LVEF) by comparing fatal and nonfatal outcomes in women and men with heart failure and a broad spectrum of left ventricular ejection fraction. METHODS AND RESULTS - We compared outcomes in 2400 women and 5199 men randomized in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program using multivariable regression analyses. A total of 1188 women (50%) had a low LVEF (≤0.40), and 1212 had a preserved LVEF (>0.40). Among the men, 3388 (65%) had a low LVEF, and 1811 had a preserved LVEF. A total of 1216 women (51%) and 3465 men (67%) had an ischemic cause of their heart failure. All-cause mortality was 21.5% in women and 25.3% in men (adjusted hazard ratio [HR], 0.77; 95% CI, 0.69 to 0.86; P<0.001). Fewer women (30.4%) than men (33.3%) experienced cardiovascular death or heart failure hospitalization (adjusted HR, 0.83; 95% CI, 0.76 to 0.91; P<0.001). The risks of sudden death (HR, 0.70; 95% CI, 0.58 to 0.85) and death due to worsening heart failure (HR, 0.72; 95% CI, 0.58 to 0.89) were reduced to a comparable extent. The adjusted risk of cardiovascular hospitalization was also lower in women (HR, 0.88; 95% CI, 0.82 to 0.95), mainly because of a reduced risk of heart failure hospitalization (HR, 0.87; 95% CI, 0.78 to 0.97). Women had a lower risk of death irrespective of cause of heart failure or LVEF. CONCLUSIONS - Among patients with heart failure, women have lower risks of most fatal and nonfatal outcomes that are not explained, as previously suggested, by LVEF or origin of the heart failure.

AB - BACKGROUND - We wished to test previous hypotheses that sex-related differences in mortality and morbidity may be due to differences in the cause of heart failure or in left ventricular ejection fraction (LVEF) by comparing fatal and nonfatal outcomes in women and men with heart failure and a broad spectrum of left ventricular ejection fraction. METHODS AND RESULTS - We compared outcomes in 2400 women and 5199 men randomized in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program using multivariable regression analyses. A total of 1188 women (50%) had a low LVEF (≤0.40), and 1212 had a preserved LVEF (>0.40). Among the men, 3388 (65%) had a low LVEF, and 1811 had a preserved LVEF. A total of 1216 women (51%) and 3465 men (67%) had an ischemic cause of their heart failure. All-cause mortality was 21.5% in women and 25.3% in men (adjusted hazard ratio [HR], 0.77; 95% CI, 0.69 to 0.86; P<0.001). Fewer women (30.4%) than men (33.3%) experienced cardiovascular death or heart failure hospitalization (adjusted HR, 0.83; 95% CI, 0.76 to 0.91; P<0.001). The risks of sudden death (HR, 0.70; 95% CI, 0.58 to 0.85) and death due to worsening heart failure (HR, 0.72; 95% CI, 0.58 to 0.89) were reduced to a comparable extent. The adjusted risk of cardiovascular hospitalization was also lower in women (HR, 0.88; 95% CI, 0.82 to 0.95), mainly because of a reduced risk of heart failure hospitalization (HR, 0.87; 95% CI, 0.78 to 0.97). Women had a lower risk of death irrespective of cause of heart failure or LVEF. CONCLUSIONS - Among patients with heart failure, women have lower risks of most fatal and nonfatal outcomes that are not explained, as previously suggested, by LVEF or origin of the heart failure.

KW - Etiology

KW - Heart failure

KW - Mortality

KW - Sex

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