The Year in Cardiology

Heart Failure: the Year in Cardiology 2019

John G.F. Cleland; Alexander R. Lyon; Theresa McDonagh; John J.V. McMurray


Eur Heart J. 2020;41(12):1232-1248. 

In This Article

Do Women and Men Respond Differently to Treatment?

An analysis of 12 058 patients with HFrEF in two large trials found that women had more severe symptoms, similar LVEF but a substantially better prognosis than men, even after adjusting for key prognostic variables including aetiology and NT-proBNP (HR: 0.68; 0.62–0.89).[96] A combined analysis of PARAGON-HF and PARADIGM-HF suggested that patients with HFrEF and HFpEF had similarly impaired quality of life but that women generally reported a worse quality of life than men.[97] In an observational analysis of patients with HFrEF, the BIOSTAT survey also found that women generally had a better prognosis than men despite being prescribed lower doses of beta-blockers and ACE inhibitors.[98] Interestingly, men and women had the same heart rate, the pharmacodynamic marker of beta-blocker dose. For patients with HFpEF in the TOPCAT trial, reductions in mortality, but not hospitalizations for heart failure, were greater for women, although the interaction was statistically significant only for all-cause mortality.[99] In the PARAGON-HF trial (HFpEF), women obtained greater benefit than men throughout the studied range of LVEF but the difference was driven by differences in the rate of hospitalization for heart failure rather than mortality.[94] One obvious difference between men and women, on average, is size. Cardiac resynchronization therapy is reputed to be more effective in women than men, but differences disappear once adjusted for height.[100] Many medicines are cleared by the kidney. Estimated glomerular filtration rate (eGFR) is indexed to body surface area (BSA) but doses of treatment are usually not. A woman (or small man) weighing 64 kg and 160 cm tall has BSA of 1.67 m2 using the Dubois formula and a man (or large woman) weighing 85 kg and 180 cm tall has a BSA 2.05 m2. If both have an eGFR of 60 mL/kg/m2, then the woman (or small man) has an un-indexed eGFR of 100 mL/min and the man (or large woman) has an un-indexed eGFR of 123 mL/min. If a medicine is cleared by the kidney then perhaps smaller people require lower doses to achieve the same plasma therapeutic concentration and clinical benefit?