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MAGGIC: HF survival better for women vs. men
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Women with HF and preserved or reduced ejection fraction appear to have better survival rates compared with men, according to results of a meta-analysis of more than 41,000 patients.
The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) analyzed data from 31 randomized and observational studies involving 28,052 men and 13,897 women with chronic HF. The data were analyzed for survival over 3 years of follow-up. During the 3 years, 25.3% of women and 25.7% of men died, representing a mortality rate of 135 deaths per 1,000 patient-years in women and 137 deaths per 1,000 patient-years in men.
According to the results, male sex was an independent predictor of mortality at 3 years (HR=1.23; 95% CI, 1.25-1.36). After adjustment for age, results showed than men had a 31% higher risk for death than women (HR=1.31; 95% CI, 1.18-1.28).
The excess mortality risk associated with male sex was of similar magnitude in patients with either reduced or preserved ejection fraction, which was not affected by either age or history of hypertension, the researchers said.
Diabetes and etiology of HF appeared to modify this relationship. More women in the study had diabetes (25.4% vs. 22.8%). Overall, 2,997 deaths were reported among 9,776 patients with diabetes (30.7%) and 7,366 deaths among 31,513 patients without diabetes (23.4%). Concomitant diabetes appeared to attenuate the lower mortality risk associated with female sex (risk for death for men vs. women: diabetes, HR=1.11; 95% CI, 1.03-1.20; no diabetes, HR=1.37; 95% CI, 1.30-1.45).
“This survival benefit may be more marked in HF of nonischemic etiology, but is clearly attenuated by concomitant diabetes,” the researchers wrote.
Compared with men, women in this study were older (70.5 vs. 65.6 years), more likely to have a history of hypertension (49.9% vs. 40%), and less likely to have a history of ischemic heart disease (46.3% vs. 58.7%) and reduced ejection fraction (62.6% vs. 81.6%). In addition, women were prescribed fewer recommended treatments for HF than men, including ACE inhibitors, angiotensin receptor blockers and beta-blockers.
“This study has clearly demonstrated that survival is better for women with HF than for men, irrespective of [ejection fraction], age or other variables,” Manuel Martínez-Selles, MD, of the Gregorio Maranon University Hospital in Madrid, Spain, said in a press release.
The researchers concluded that further study is required to determine the biological reasons for the better prognosis in women with HF.
Disclosure: Dr. Martínez-Selles reports no relevant financial disclosures.
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