Atlantic International Partnership Headlines: Women Have Better Heart-failure Survival Than Men

Madrid, Spain - Women with heart failure have better survival than men

, independent of ejection fraction, according to the results of a new large individual patient meta-analysis of heart-failure studies [1].

Lead author Dr Manuel Martnez-Selles (Hospital General Universitario Gregorio Maran, Madrid, Spain) commented to heartwire: Previous studies have hinted at a better prognosis for women with heart failure, but they have generally not been big enough to show this definitively. We have analyzed individual patient data from 31 studies in 41 949 patients, and we can now say with certainty that females have a better survival than males with the same degree of heart failure. This is an independent effect. The difference definitely has to do with gender, and it is not explained by age or ventricular function.

For the meta-analysis, published online in the European Journal of Heart Failure on March 8, 2012, researchers from the Meta-Analysis Global Group In Chronic Heart Failure (MAGGIC) combined data from 28 052 men and 13 897 women with heart failure. During three years of follow-up, 25% of the women and 26% of the men died. Women were older than men, more likely to have a history of hypertension, and less likely to have a history of ischemic heart disease and reduced EF, but after adjustment for these factors, male gender was an independent predictor of mortality.

Smaller effect in ischemic etiology and diabetics

Results also showed that the gender difference in survival was present in both heart failure of ischemic and nonischemic origin but was larger in the nonischemic patients. Martnez-Selles suggested that women with ischemic heart failure presented more like a male, and when there was such a large assault on the heart as an MI, the degree of protection from being female was probably not so important. Whereas nonischemic heart failure is a more gradual process, and therefore the female protection may be more obvious.

Similarly, the better survival in females was less pronounced in patients with diabetes than those without diabetes. Martnez-Selles said: Diabetics are known to have a worse heart-failure prognosis, so in this population we can expect to see less of an effect from the gender difference.

In the paper, the researchers note that the interaction between diabetes status and sex-related outcomes is robust, whereas the interaction with etiology is less certain.

Is the female heart stronger?

On possible reasons for the finding of improved survival in women, Martnez-Selles said there were a few studies suggesting that the female heart may be stronger than that of the male. Right ventricular function may be important, and women are usually better in this regard, he commented.

He speculated that women simply may be born with stronger hearts, citing animal studies that have shown it is easier to induce ventricular arrhythmias in male hearts than in female hearts. And females have been shown to have better remodeling after an MI.

Another hypothesis is that pregnancy makes the heart stronger. Studies have shown that during pregnancy, there are positive changes in the heart that persist for many years after. Women get better left and right ventricular function. And there are reports of female athletes performing better after pregnancy, Martnez-Selles noted.

He added that autopsies of women who have had a male child have shown the presence of a Y chromosome in their myocardial cells. It appears that stem cells from the baby may incorporate themselves into the heart of the mother, which may make her heart younger.

by: atlanticint

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