Are Optimal Doses of Heart Failure Medications the Same for Men and Women?
BACKGROUND AND PURPOSE
- Medications for heart failure with reduced
ejection fraction (HFrEF) include
- Angiotensin-converting-enzyme (ACE) inhibitors | Angiotensin-receptor blockers (ARBs) | β blockers
- Men and women are prescribed the same doses
- Santema et al. (Lancet, 2019) investigated whether there are sex differences in the optimal doses of these medications for HFrEF
METHODS
- Post-hoc analysis of prospective BIOSTAT-CHF
study (11 European countries)
- Study to evaluate heart failure treatment with left ventricular ejection fraction less than 40%
- Findings were validated in ASIAN-HF, an independent cohort of 3539 men and 961 women with HFrEF
- Primary outcome
- A composite of time to all-cause mortality or hospitalization for heart failure
RESULTS
- 1,308 men and 402 women
- Women were
- Older (74 vs 70 years; p<0.0001)
- Lower bodyweights (72 kg vs 85 kg; p<0.0001)
- Heights (162 cm vs 174 cm; p<0.0001)
- No difference in BMI
- A similar number of men and women reached guideline-recommended target doses
- Sex differences related to drug dosage and risk for death or hospitalizations for heart failure
- Men: Lowest numbers of death or hospitalizations for heart failure occurred at 100% of the recommended medication dose
- Women: 30% lower risk of death or hospitalizations at only 50% of the recommended doses and no further decrease in risk at higher dose levels
- Adjusting for age and body surface area did not alter results
- Findings were similar in the second ASIAN-HF study
CONCLUSION
- Women may require half the dose of heart failure medications compared to men
- This finding is particularly important as literature demonstrates that women may have more adverse drug reactions and these reactions may be more severe than those seen in men
- This study highlights the pervasive bias towards male-based medical guidelines in research and in addition the authors state
This study also underlines the importance of performing prespecified sex-specific analyses in all drug trials
