Gender differences in pharmacotherapy of chronic heart failure

At this point, guidelines recommend the same care for patients with chronic heart failure (HF), regardless of gender. In the future, however, HF care may need to be tailored by sex, as the best way to optimize outcomes for both men and women. Because prior studies demonstrated sex-related differences in many aspects of HF care (in the appropriate use and dosing of evidence-based therapy and in the individual response to pharmacological treatment between women and men with HF). In general, benefit of beta-blockers, ACE inhibitors, angiotensin II receptor blockers (ARBs) and spironolactone in clinical trials was similar, regardless of gender. Women with HF appear to have significantly lower mortality rates on ARBs than on the more standard HF therapy (ACE inhibitors), but there was no difference in survival in men prescribed ARBs compared to ACE inhibitors. In a post hoc subgroup analysis digoxin was associated with a increased risk of death from any cause among women with HF, but not men. ACE inhibitor-induced cough was more frequent among women. The risk of hyperkalemia was increased with male gender in HF patients treated with candesartan. The use of spironolactone was inversely associated with fractures in men with CHF. Previous studies have suggested that female with HF are less likely received guideline-recommended therapies (in appropriate doses). Female patients with HF were less likely to receive certain guideline-recommended evidence-based treatments, but the influence of patient sex on delivery of these therapies was disappeared when the objective reasons for non-using of these therapies were taken into account. These sex differences could have potential widespread implications for routine heart failure care.

Keywords: gender; sex; female; women; heart failure