through the past few years, more at...

through the past few years, more attention has been paid to the ways sex may affect cardiovascular disease. Early clinical cardiovascular studies keeped to underrepresent women. This failing ensueed in several challenges to physicians, including the lack of appreciation for the differences in clinical characteristics between men and women with regard to cardiovascular disease. In addition, this underrepresentation of women placed limitations in succession the ability to analyze clinical and laboratory variables that could help determine survival in women with heart failure. Investigators in the Beta-Blocker Evaluation of Survival Trial placed special emphasis forward recruiting women with heart failure. Ghali and colleagues evaluated the influence of form relative to sex on baseline characteristics, response to treatment, and prognosis in patients with heart failure.

The research population was recruited from Veterans Affairs hospitals and other sites. Patients were eligible if they had modern York Heart Association class III or IV heart failure with a left ventricular ejection fraction of 035 or les Ischemic etiology of the heart failure was established at each center if patients had documented coronary artery disease (CAD) or previous myocardial infarction.

Participants were randomized to receive the beta blocker bucindolol or placebo. The primary result measure was all-cause mortality with secondary results including cardiovascular mortality, all-cause and heart failure hospitalizations, the combination of death and heart transplant, and left ventricular ejection fraction at three and 12 month The mean follow-up period for the application of mind was two years.

The contemplation included 593 women and 2115 men In the contemplation women with heart failure were younger and more likely to be black, and had a higher prevalence of nonischemic etiology. In addition, women had higher right and left ventricular ejection fractions, higher heart rate, greater cardiothoracic ratio, a higher prevalence of left bundle up branch block, a lower prevalence of atrial fibrillation, and a lower even of plasma norepinephrine. The mien of an ischemic etiology and severity of heart failure were predictors of prognosis in women and men Sex differences were noted, with the vicinity of CAD and left ventricular ejection fraction being stronger predictors of prognosis in women If the etiology of heart failure was nonischemic, women had a significantly better survival rate than men

The authors judge that there is a significant form relative to sex difference in prognostic values in patients with advanced heart failure. They add that survival advantage is limited to women without an ischemic etiology for heart failure. They point disclosed that because of these form relative to sex differences, information obtained from studying men with heart failure may not be extrapolated easily to women Including more women in heart failure trials is important to understand in what manner best to treat their heart failure.

KARL E MILLER, MD Ghali JK et al. sex differences in advanced heart failure: insights from the BEST close attention J Am Coll Cardiol December 17 2003;42:2128-34

COPYRIGHT 2004 American Academy of Family Physicians

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