Sex differences in efficacy of pharmacological therapies in heart failure with reduced ejection fraction : a meta-analysis
Danielson, Cecilia ; Lileikyte, Gabriele LU
; Ouwerkerk, Wouter
; S.P. Lam, Carolyn
; Erlinge, David
LU
and Teng, Tiew Hwa Katherine
(2022)
In ESC Heart Failure
9(4).
p.2753-2761
- Abstract
Aims: Recent studies have suggested potential sex differences in treatment response to pharmacological therapies in heart failure (HF). We performed a systematic review and meta-analysis of studies comparing treatment effects between men and women with HF and reduced ejection fraction (HFrEF) using established guideline-directed medical therapy and other emerging pharmacological treatments. Methods and results: Systematic search was performed on PubMed, Embase, and Cochrane Library for randomized controlled trials published in 1990–2021. Outcomes were all-cause mortality and combined outcome of all-cause mortality and/or hospitalization for HF. Of 618 articles identified, 25 articles and 100 213 patients (mean age 62 ± 1.7 years, women... (More)
Aims: Recent studies have suggested potential sex differences in treatment response to pharmacological therapies in heart failure (HF). We performed a systematic review and meta-analysis of studies comparing treatment effects between men and women with HF and reduced ejection fraction (HFrEF) using established guideline-directed medical therapy and other emerging pharmacological treatments. Methods and results: Systematic search was performed on PubMed, Embase, and Cochrane Library for randomized controlled trials published in 1990–2021. Outcomes were all-cause mortality and combined outcome of all-cause mortality and/or hospitalization for HF. Of 618 articles identified, 25 articles and 100 213 patients (mean age 62 ± 1.7 years, women 23.1%, mean left ventricular ejection fraction 26.6 ± 1.3%) were included in the systematic review and meta-analysis. For the outcome of all-cause mortality, there was no evidence of treatment heterogeneity by sex for renin-angiotensin system inhibitors (RASi) [hazard ratio (HR) 0.86 (95% confidence interval 0.75–0.99) in men; HR 0.97 (0.77–1.23) in women; Pinteraction = 0.288], or for beta-blockers (BB) [HR 0.71 (0.59–0.86) in men; HR 0.87 (0.73–1.03) in women; Pinteraction = 0.345]. Similarly, for the composite outcome of death or HF hospitalization, there was no evidence of treatment heterogeneity by sex for RASi [HR 0.84 (0.77–0.93) in men; HR 0.94 (0.81–1.08) in women; Pinteraction = 0.210] or BB [HR 0.76 (0.64–0.90) in men; HR 0.72 (0.60–0.86) in women; Pinteraction = 0.650]. Results for mineralocorticoid receptor antagonists (MRA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) from previously published meta-analyses were included in the review. For the combined outcome of cardiovascular death or HF hospitalization, no significant interaction for sex was observed for MRA (Pinteraction = 0.78) or SGLT2i (Pinteraction = 0.37). Results for emerging pharmacological treatments, such as soluble guanylate cyclase stimulators and cardiac myosin activators, were included in the review and showed consistent treatment effects between men and women. Conclusions: Our meta-analysis showed no differences between sex in treatment effect for BB and RASi. Review on previously published trials for MRA, SGLT2i, and emerging therapies presented consistent treatment effects between men and women.
(Less)
- author
- Danielson, Cecilia
; Lileikyte, Gabriele
LU
; Ouwerkerk, Wouter
; S.P. Lam, Carolyn
; Erlinge, David
LU
and Teng, Tiew Hwa Katherine
- organization
- publishing date
- 2022-08
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Guideline-directed medical therapy, Heart failure with reduced ejection fraction, Pharmacology, Sex differences
- in
- ESC Heart Failure
- volume
- 9
- issue
- 4
- pages
- 9 pages
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- scopus:85130265262
- pmid:35603531
- ISSN
- 2055-5822
- DOI
- 10.1002/ehf2.13974
- language
- English
- LU publication?
- yes
- id
- e7b9f452-e6d9-478d-8a5a-5a3ea446b95b
- date added to LUP
- 2022-12-27 14:15:28
- date last changed
- 2024-07-12 02:42:58
@article{e7b9f452-e6d9-478d-8a5a-5a3ea446b95b,
abstract = {{<p>Aims: Recent studies have suggested potential sex differences in treatment response to pharmacological therapies in heart failure (HF). We performed a systematic review and meta-analysis of studies comparing treatment effects between men and women with HF and reduced ejection fraction (HFrEF) using established guideline-directed medical therapy and other emerging pharmacological treatments. Methods and results: Systematic search was performed on PubMed, Embase, and Cochrane Library for randomized controlled trials published in 1990–2021. Outcomes were all-cause mortality and combined outcome of all-cause mortality and/or hospitalization for HF. Of 618 articles identified, 25 articles and 100 213 patients (mean age 62 ± 1.7 years, women 23.1%, mean left ventricular ejection fraction 26.6 ± 1.3%) were included in the systematic review and meta-analysis. For the outcome of all-cause mortality, there was no evidence of treatment heterogeneity by sex for renin-angiotensin system inhibitors (RASi) [hazard ratio (HR) 0.86 (95% confidence interval 0.75–0.99) in men; HR 0.97 (0.77–1.23) in women; P<sub>interaction</sub> = 0.288], or for beta-blockers (BB) [HR 0.71 (0.59–0.86) in men; HR 0.87 (0.73–1.03) in women; P<sub>interaction</sub> = 0.345]. Similarly, for the composite outcome of death or HF hospitalization, there was no evidence of treatment heterogeneity by sex for RASi [HR 0.84 (0.77–0.93) in men; HR 0.94 (0.81–1.08) in women; P<sub>interaction</sub> = 0.210] or BB [HR 0.76 (0.64–0.90) in men; HR 0.72 (0.60–0.86) in women; P<sub>interaction</sub> = 0.650]. Results for mineralocorticoid receptor antagonists (MRA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) from previously published meta-analyses were included in the review. For the combined outcome of cardiovascular death or HF hospitalization, no significant interaction for sex was observed for MRA (P<sub>interaction</sub> = 0.78) or SGLT2i (P<sub>interaction</sub> = 0.37). Results for emerging pharmacological treatments, such as soluble guanylate cyclase stimulators and cardiac myosin activators, were included in the review and showed consistent treatment effects between men and women. Conclusions: Our meta-analysis showed no differences between sex in treatment effect for BB and RASi. Review on previously published trials for MRA, SGLT2i, and emerging therapies presented consistent treatment effects between men and women.</p>}},
author = {{Danielson, Cecilia and Lileikyte, Gabriele and Ouwerkerk, Wouter and S.P. Lam, Carolyn and Erlinge, David and Teng, Tiew Hwa Katherine}},
issn = {{2055-5822}},
keywords = {{Guideline-directed medical therapy; Heart failure with reduced ejection fraction; Pharmacology; Sex differences}},
language = {{eng}},
number = {{4}},
pages = {{2753--2761}},
publisher = {{John Wiley & Sons Inc.}},
series = {{ESC Heart Failure}},
title = {{Sex differences in efficacy of pharmacological therapies in heart failure with reduced ejection fraction : a meta-analysis}},
url = {{http://dx.doi.org/10.1002/ehf2.13974}},
doi = {{10.1002/ehf2.13974}},
volume = {{9}},
year = {{2022}},
}