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Gender Specifics

 

Currently, standard practice is to prescribe the same pharmaceutical treatment to both men and women [7][8]. Remember that in heart failure research, which includes drug trials, women have been significantly under-represented.

 

In the trials that did include women, and collected gender specific data, the following results were found:

  • Beta blockers have equal effect in men and women [5][6]

  • Angiotensin II antagonist has been shown to reduce mortality and morbidity equally in men and women [9,10]

The story with ACE-inhibitors is more complex:

  • One trial showed that women received no benefit, while men saw a 51% reduction in mortality [11]

  • Another trial showed that women do in fact receive a reduction in mortality and morbidity, though not to the same extent as men. [12]

  • Finally, another study found that both genders receive equal positive effects from ACE-inhibitors [13], and that women with CHF had a 15-20% reduction in mortality risk when treated with ACE-inhibitors. Also, women had a 20% reduction in the risk of combined endpoints, such as mortality, readmission and re-infarction. [14]

At the moment it is essentially unclear as to whether men and women should be prescribed similar doses of these drugs, mainly due to the lack of women in drug trials [15]

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5. Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, Shusterman NH.The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S.Carvedilol Heart Failure Study Group.New Engl J Med 1996;334:1349 –55.

6. Hjalmarson A, Goldstein S, Fagerberg B.Effects of controlledrelease metoprolol on total mortality, hospitalizations, and wellbeing in patients with heart failure: the Metoprolol CRyXL Randomized Intervention Trial in congestive heart failure (MERIT-HF).JAMA 2000;283:1295 –302.

7. The Task Force of the Working Group on Heart Failure of the European Society of Cardiology.Guidelines for the diagnosis and treatment of chronic heart failure.Eur Heart J 2001;22:1527 –60.

8. Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldmanmd AM, Francis GS, Ganiats TG, Goldstein S, Gregoratos G, Jessup ML, Noble RJ, Packer M, Silver MA, Stevenson LW, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Jacobs AK, Hiratzka LF, Russell RO, Smith SC Jr.ACC yAHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary.A report of the American College of CardiologyyAmerican Heart Association Task Force on practice guidelines. (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration with the International Society for Heart and Lung Transplantation; Endorsed by the Heart Failure Society of America.Cir culation 2001;104:2996 –3007.

11. CONSENSUS trial study group.Effect of enalapril on mortality in severe congestive heart failure.N Engl J Med 1987;316:1429 –35.

12. The SOLVD investigators.Effect of enalapril on survival in patients with reduced left ventricular ejection fraction and congestive heart failure.N Engl J Med 1991;325:293 –302.

13. Garg R, Yusuf S, for the Collaborative Group on ACE Inhibitors Trials S.Overview of randomized trials of angiotensin converting enzyme inhibitors on mortality and morbidity in heart failure.JAMA 1995;273:1450 –6.

14. Flather MD, Yusuf S, Kober L, Pfeffer M, Hall A, Murray G, et al. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: A systematic overview of data from individual patients. ACE-inhibitor myocardial infarction collaborative group. Lancet. 2000;355(9215):1575–1581.

15. Stromberg A, Martensson J. Gender differences in patients with heart failure. European Journal of Cardiovascular Nursing. 2003;2:7-18.

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