PMID- 36198840 OWN - NLM STAT- MEDLINE DCOM- 20230626 LR - 20230626 IS - 1573-7322 (Electronic) IS - 1382-4147 (Linking) VI - 28 IP - 4 DP - 2023 Jul TI - Sex-specific differences in the efficacy of heart failure therapies: a meta-analysis of 84,818 patients. PG - 949-959 LID - 10.1007/s10741-022-10275-1 [doi] AB - Women have been historically underrepresented in clinical trials of heart failure (HF). We aimed to assess for sex differences in patient characteristics and the efficacy of guideline-directed medical therapy (GDMT) in HF. Systematic literature search for randomized controlled trials (RCTs) of GDMT reporting cardiovascular outcomes by sex in patients with HF. The primary outcome was the composite of cardiovascular death and hospitalization for HF. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using inverse variance weighting and random effects meta-analysis. Twenty-six RCTs totaling 84,818 participants (27% women) were included. Women with HF were older, had higher New York Heart Association (NYHA) class, more hypertension and obesity, and higher mean left ventricular ejection fraction compared to men. There was evidence for most GDMT in reducing the primary outcome in women with HF with reduced ejection fraction (HFrEF) (angiotensin-converting enzyme inhibitors/angiotensin-receptor blocker [RR 0.86, 95% CI 0.75-0.97], angiotensin-receptor blocker/neprilysin inhibitor (ARNI) [RR 0.77, 95% CI 0.62-0.94], beta-blocker [RR 0.67, 95% CI 0.51-0.89], ivabradine [RR 0.74, 95% CI 0.60-0.91], and sodium-glucose cotransporter-2 (SGLT2) inhibitors [RR 0.66, 95% CI 0.54-0.81]) and a non-significant trend for benefit with mineralocorticoid-receptor-antagonist (MRA) [RR 0.77, 95% CI 0.52-1.16]). Compared to men with HFrEF, GDMT reduced the primary outcome in women to a similar degree across all drug classes (ratio of RR 1.05, 95% CI 0.96-1.14). Despite differences in baseline characteristics and an underrepresentation of women in HF clinical trials, GDMT are as efficacious in women as compared to men in reducing cardiovascular events in HF. CI - (c) 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. FAU - Wang, Nelson AU - Wang N AUID- ORCID: 0000-0002-8197-5090 AD - The George Institute for Global Health, UNSW, Sydney, Australia. nwan5905@uni.sydney.edu.au. AD - Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. nwan5905@uni.sydney.edu.au. AD - Sydney Medical School, University of Sydney, Sydney, Australia. nwan5905@uni.sydney.edu.au. FAU - Evans, Jack AU - Evans J AD - St. Vincent's Hospital, Sydney, Australia. FAU - Sawant, Sonia AU - Sawant S AD - Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. FAU - Sindone, James AU - Sindone J AD - Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. FAU - Lal, Sean AU - Lal S AD - Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. AD - Sydney Medical School, University of Sydney, Sydney, Australia. LA - eng PT - Journal Article PT - Meta-Analysis PT - Review DEP - 20221006 PL - United States TA - Heart Fail Rev JT - Heart failure reviews JID - 9612481 RN - 3H48L0LPZQ (Ivabradine) RN - 0 (Angiotensin Receptor Antagonists) RN - 0 (Angiotensins) SB - IM MH - Male MH - Female MH - Humans MH - *Sex Characteristics MH - *Heart Failure/drug therapy MH - Ivabradine MH - Angiotensin Receptor Antagonists MH - Stroke Volume MH - Angiotensins OTO - NOTNLM OT - Heart failure OT - Meta-analysis OT - Sex differences EDAT- 2022/10/06 06:00 MHDA- 2023/06/26 06:41 CRDT- 2022/10/05 23:27 PHST- 2022/09/20 00:00 [accepted] PHST- 2023/06/26 06:41 [medline] PHST- 2022/10/06 06:00 [pubmed] PHST- 2022/10/05 23:27 [entrez] AID - 10.1007/s10741-022-10275-1 [pii] AID - 10.1007/s10741-022-10275-1 [doi] PST - ppublish SO - Heart Fail Rev. 2023 Jul;28(4):949-959. doi: 10.1007/s10741-022-10275-1. Epub 2022 Oct 6.