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Canadian Journal of Cardiology

Sex-Specific Differences in Heart Failure: Pathophysiology, Risk Factors, Management, and Outcomes

Published:December 28, 2020DOI:https://doi.org/10.1016/j.cjca.2020.12.025

      Abstract

      Heart failure (HF) is a leading cause of hospitalisation, morbidity, and mortality in Canada. There are sex-specific differences in the etiology, epidemiology, comorbidities, treatment response, and treatment adverse effects that have implications on outcomes in HF. Sex-specific analyses of some HF trials indicate that optimal doses of drug therapies and benefit of device therapies may differ between male and female patients, but the trials were not designed to test sex differences. The under-representation of female participants in HF randomised controlled trials (RCTs) is a major limitation in assessing the sex-specific efficacy and safety of treatments. To ensure that female patients receive safe and effective HF therapies, RCTs should include participants proportionate to the sex-specific distribution of disease. This review outlines the sex-specific differences in HF phenotype and treatment response, and highlights disparities in services and gaps in knowledge that merit further investigation.

      Résumé

      L’insuffisance cardiaque (IC) est l’une des principales causes d’hospitalisation, de morbidité et de mortalité au Canada. Il existe des différences entre les sexes sur les plans de l’étiologie, de l’épidémiologie, des affections concomitantes, de la réponse au traitement et des effets indésirables des traitements, qui ont toutes des répercussions sur les résultats de l’IC. Les analyses des résultats de certains essais sur l’IC selon le sexe des participants révèlent qu’il existe des différences entre les doses optimales des pharmacothérapies et les bienfaits des dispositifs thérapeutiques chez les hommes et les femmes, mais les essais ne sont pas conçus pour évaluer les différences entre les sexes. La sous-représentation des femmes au sein des essais contrôlés avec répartition aléatoire sur l’IC constitue une limite importante pour l’évaluation de l’efficacité et de l’innocuité des traitements selon le sexe. Afin que les patientes atteintes d’IC puissent recevoir des traitements sûrs et efficaces, les participants aux essais contrôlés avec répartition aléatoire doivent être représentatifs de la distribution des cas d’IC selon le sexe dans la population. Nous décrivons brièvement les différents phénotypes de l’IC et les différentes réponses au traitement chez les hommes et les femmes, et nous soulignons les disparités en matière de services ainsi que les lacunes dans les connaissances qui mériteraient d’être étudiées plus en profondeur.
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