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12. Sex differences in factors associated with heart failure and diastolic left ventricular dysfunction: a cross-sectional population-based study.

Author

Cesaroni, Giulia, Mureddu, Gian Francesco, Agabiti, Nera, Mayer, Flavia, Stafoggia, Massimo, Forastiere, Francesco, Latini, Roberto, Masson, Serge, Davoli, Marina, Boccanelli, Alessandro, on behalf of the PREDICTOR Study Group, Boccanelli, A., Cacciatore, G., Mureddu, G. F., Rizzello, V., Agabiti, N., Cesaroni, G., Forastiere, F., Perucci, C. A., and Davoli, M.

Subjects
CARDIOVASCULAR diseases risk factors, HEART failure risk factors, SEX differences in the heart, LIFESTYLES & health, DISEASE prevalence, ATRIAL fibrillation, DISEASES in older people, LEFT ventricular dysfunction
Abstract

Background: Although sex differences in cardiovascular diseases are recognised, including differences in incidence, clinical presentation, response to treatments, and outcomes, most of the practice guidelines are not sex-specific. Heart failure (HF) is a major public health challenge, with high health care expenditures, high prevalence, and poor clinical outcomes. The objective was to analyse the sex-specific association of socio-demographics, life-style factors and health characteristics with the prevalence of HF and diastolic left ventricular dysfunction (DLVD) in a cross-sectional population-based study.Methods: A random sample of 2001 65-84 year-olds underwent physical examination, laboratory measurements, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), electrocardiography, and echocardiography. We selected the subjects with no missing values in covariates and echocardiographic parameters and performed a complete case analysis. Sex-specific multivariable logistic regression models were used to identify the factors associated with the prevalence of the diseases, multinomial logistic regression was used to investigate the factors associated to asymptomatic and symptomatic LVD, and spline curves to display the relationship between the conditions and both age and NT-proBNP.Results: In 857 men included, there were 66 cases of HF and 408 cases of DLVD (77% not reporting symptoms). In 819 women, there were 51 cases of HF and 382 of DLVD (79% not reporting symptoms). In men, the factors associated with prevalence of HF were age, ischemic heart disease (IHD), and suffering from three or more comorbid conditions. In women, the factors associated with HF were age, lifestyles (smoking and alcohol), BMI, hypertension, and atrial fibrillation. Age and diabetes were associated to asymptomatic DLVD in both genders. NT-proBNP levels were more strongly associated with HF in men than in women.Conclusions: There were sex differences in the factors associated with HF. The results suggest that prevention policies should consider the sex-specific impact on cardiac function of modifiable cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Published
2021
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14. Seven-year follow-up after dobutamine stress echocardiography - Impact of gender on prognosis

Author

BIAGINI, ELENA, RAPEZZI, CLAUDIO, BRANZI, ANGELO, ELHENDY A, BAX JJ, RIZZELLO V, SCHINKEL AF, VAN DOMBURG RT, KERTAI MD, KRENNING BJ, BOUNTIOUKOS M, SIMOONS ML, POLDERMANS D., Cardiology, BIAGINI E, ELHENDY A, BAX JJ, RIZZELLO V, SCHINKEL AF, VAN DOMBURG RT, KERTAI MD, KRENNING BJ, BOUNTIOUKOS M, RAPEZZI C, BRANZI A., SIMOONS ML, and POLDERMANS D.

Abstract

ObjectivesThe aim of this study was to investigate the effects of gender on long-term prognosis of patients undergoing dobutamine stress echocardiography (DSE).BackgroundGender differences in the predictors of outcome among patients with known or suspected coronary artery disease undergoing DSE have not been adequately studied.MethodsWe studied 2,276 men and 1,105 women with known or suspected coronary artery disease who underwent DSE. Follow-up events were cardiac death and nonfatal myocardial infarction (MI).ResultsDobutamine stress echocardiography was normal in 687 men (30%) and 483 women (44%) (p < 0.0001). Ischemia on DSE was present in 1,194 men (52%) and 416 women (38%) (p < 0.001). During a mean follow-up of 7 ± 3.4 years, there were 894 (26%) deaths (442 attributed to cardiac causes) and 145 (4%) nonfatal MIs. The annual cardiac event rate was 2.5% in men and 1.2% in women with normal DSE. Independent predictors of cardiac events in patients with normal DSE using a Cox proportional hazards regression analysis were male gender (hazard ratio [HR]: 1.7 [range 1.1 to 2.8]), age (HR: 1.02 [range 1.01 to 1.04]), history of heart failure (HR: 3.4 [range 1.5 to 7.9]), previous MI (HR: 1.7 [range 1.1 to 2.8]), and diabetes (HR: 2.4 [range 1.3 to 4.5]). Independent predictors of cardiac events in patients with an abnormal DSE were age (HR: 1.03 [range 1.02 to 1.04]), history of heart failure (HR: 1.7 [range 1.3 to 2.1]), diabetes (HR: 1.4 [range 1.1 to 1.8]), heart rate at rest (HR: 2.8 [range 1.4 to 5.8]), wall motion abnormalities at rest (HR: 1.06 [range 1.04 to 1.09]), and ischemia on DSE (HR: 1.04 [range 1.02 to 1.07]). Myocardial ischemia was an independent predictor of cardiac events in both men and women.ConclusionsDobutamine stress echocardiography provides independent prognostic information in both men and women. In patients with normal DSE, gender is independently associated with cardiac events. The outcome of patients with abnormal DSE is not related to gender, after adjusting for stress echocardiographic abnormalities.

Published
2005

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