Revisiting October’s Insights: Heart Failure in women – the sex gap

Women are underrepresented in heart failure clinical trials due to various barriers and often exhibit worse symptoms and a higher burden of heart failure signs than men. Despite men potentially reporting a better quality of life, they have worse survival rates. Disparities in treatment also exist, with women less frequently utilizing certain heart failure medications and devices. Furthermore, studies suggest that women may achieve peak benefits at lower dosages of some medications. There is a critical need for further research to address these disparities and optimize treatment strategies for women.

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Jelena Celutkiene:   And now, let’s have a look at the most important heart failure trials, which are summarized here. You see the number of heart failure drugs, the absolute number of women, and the proportion of women in all heart failure trials that are important for our treatment today. What we can see here is that in some trials, when you do this sex-specific analysis after the trial is over, in some cases we see no significant benefit in women – metoprolol; no benefit in women – enalapril; no significant benefit in women – carvedilol, and so on. Some trials show significant benefit in both men and women, like sacubitril/valsartan in PARADIGM. So, we also have to be cautious in interpreting this analysis because it is only subgroups, and as you see, again, from quite a low proportion of female sex. And that’s why we still have to keep the interpretation of the trial overall because the more subgroup analyses we do, the more positive results we can get just by chance. Now, several more recent trials, and these already were trials with HFpEF like TOPCAT, like PARAGON. And you see again some intriguing results. For example, TOPCAT, as already was shown, reduction of all-cause mortality in women only. And then it was thought maybe myocardial sensitivity to aldosterone is higher in women. And again, PARAGON, as you all very well know, sacubitril/valsartan also showed more favorable effects in women. But SGLT2 inhibitors – similar benefits in women and men, no difference from this subgroup analysis. And as also Marta pointed, well tolerance in both sexes.