Massimo Iacoviello1,2, Rosanna Pugliese3, Michele Correale4, Natale Daniele Brunetti4,3. 1. Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, Foggia, Italy. massimo.iacoviello@unifg.it. 2. Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy. massimo.iacoviello@unifg.it. 3. Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy. 4. Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, Foggia, Italy.
Abstract
PURPOSE OF REVIEW: Over the last decades, several classes of drugs have been introduced for the treatment of patients with heart failure with reduced ejection fraction (HFrEF). Their use has been supported by randomized controlled trials that have demonstrated improved patient outcomes. However, these trials enrolled a small number of female patients and sometimes have reported gender-related differences regarding the efficacy of the treatments. The aim of this review is to revise the available data about the influence of gender on the optimal treatment and drug dose in patients with HFrEF. RECENT FINDINGS: Several gender-related differences in terms of pharmacokinetic and pharmacodynamic characteristics of the drugs have been described. These characteristics could be responsible for a different response and tolerability in men and women also when current recommended treatment of HFrEF is considered. Some studies have shown that, in women, lower doses of beta-blockers and inhibitors of renin angiotensin aldosterone system could be equally effective than higher doses in men, whereas sacubitril/valsartan could exert its favorable effect at greater values of left ventricular ejection fraction. Although there is evidence about differences in the response to treatment of HFrEF in men and women, this has not been sufficient for differentiating current recommended therapy. Further studies should better clarify if the treatment of HFrEF should be based also on the patients' gender.
PURPOSE OF REVIEW: Over the last decades, several classes of drugs have been introduced for the treatment of patients with heart failure with reduced ejection fraction (HFrEF). Their use has been supported by randomized controlled trials that have demonstrated improved patient outcomes. However, these trials enrolled a small number of female patients and sometimes have reported gender-related differences regarding the efficacy of the treatments. The aim of this review is to revise the available data about the influence of gender on the optimal treatment and drug dose in patients with HFrEF. RECENT FINDINGS: Several gender-related differences in terms of pharmacokinetic and pharmacodynamic characteristics of the drugs have been described. These characteristics could be responsible for a different response and tolerability in men and women also when current recommended treatment of HFrEF is considered. Some studies have shown that, in women, lower doses of beta-blockers and inhibitors of renin angiotensin aldosterone system could be equally effective than higher doses in men, whereas sacubitril/valsartan could exert its favorable effect at greater values of left ventricular ejection fraction. Although there is evidence about differences in the response to treatment of HFrEF in men and women, this has not been sufficient for differentiating current recommended therapy. Further studies should better clarify if the treatment of HFrEF should be based also on the patients' gender.
Authors: Faiez Zannad; John J V McMurray; Henry Krum; Dirk J van Veldhuisen; Karl Swedberg; Harry Shi; John Vincent; Stuart J Pocock; Bertram Pitt Journal: N Engl J Med Date: 2010-11-14 Impact factor: 91.245
Authors: John J V McMurray; Scott D Solomon; Silvio E Inzucchi; Lars Køber; Mikhail N Kosiborod; Felipe A Martinez; Piotr Ponikowski; Marc S Sabatine; Inder S Anand; Jan Bělohlávek; Michael Böhm; Chern-En Chiang; Vijay K Chopra; Rudolf A de Boer; Akshay S Desai; Mirta Diez; Jaroslaw Drozdz; Andrej Dukát; Junbo Ge; Jonathan G Howlett; Tzvetana Katova; Masafumi Kitakaze; Charlotta E A Ljungman; Béla Merkely; Jose C Nicolau; Eileen O'Meara; Mark C Petrie; Pham N Vinh; Morten Schou; Sergey Tereshchenko; Subodh Verma; Claes Held; David L DeMets; Kieran F Docherty; Pardeep S Jhund; Olof Bengtsson; Mikaela Sjöstrand; Anna-Maria Langkilde Journal: N Engl J Med Date: 2019-09-19 Impact factor: 91.245
Authors: Marcus D Flather; Marcelo C Shibata; Andrew J S Coats; Dirk J Van Veldhuisen; Aleksandr Parkhomenko; Joszef Borbola; Alain Cohen-Solal; Dan Dumitrascu; Roberto Ferrari; Philippe Lechat; Jordi Soler-Soler; Luigi Tavazzi; Lenka Spinarova; Jiri Toman; Michael Böhm; Stefan D Anker; Simon G Thompson; Philip A Poole-Wilson Journal: Eur Heart J Date: 2005-01-09 Impact factor: 29.983
Authors: Deepak L Bhatt; Michael Szarek; P Gabriel Steg; Christopher P Cannon; Lawrence A Leiter; Darren K McGuire; Julia B Lewis; Matthew C Riddle; Adriaan A Voors; Marco Metra; Lars H Lund; Michel Komajda; Jeffrey M Testani; Christopher S Wilcox; Piotr Ponikowski; Renato D Lopes; Subodh Verma; Pablo Lapuerta; Bertram Pitt Journal: N Engl J Med Date: 2020-11-16 Impact factor: 91.245
Authors: Piotr Ponikowski; Bridget-Anne Kirwan; Stefan D Anker; Theresa McDonagh; Maria Dorobantu; Jarosław Drozdz; Vincent Fabien; Gerasimos Filippatos; Udo Michael Göhring; Andre Keren; Irakli Khintibidze; Hans Kragten; Felipe A Martinez; Marco Metra; Davor Milicic; José C Nicolau; Marcus Ohlsson; Alexander Parkhomenko; Domingo A Pascual-Figal; Frank Ruschitzka; David Sim; Hadi Skouri; Peter van der Meer; Basil S Lewis; Josep Comin-Colet; Stephan von Haehling; Alain Cohen-Solal; Nicolas Danchin; Wolfram Doehner; Henry J Dargie; Michael Motro; Javed Butler; Tim Friede; Klaus H Jensen; Stuart Pocock; Ewa A Jankowska Journal: Lancet Date: 2020-11-13 Impact factor: 79.321
Authors: John J V McMurray; Milton Packer; Akshay S Desai; Jianjian Gong; Martin P Lefkowitz; Adel R Rizkala; Jean L Rouleau; Victor C Shi; Scott D Solomon; Karl Swedberg; Michael R Zile Journal: N Engl J Med Date: 2014-08-30 Impact factor: 91.245
Authors: Christopher B Granger; John J V McMurray; Salim Yusuf; Peter Held; Eric L Michelson; Bertil Olofsson; Jan Ostergren; Marc A Pfeffer; Karl Swedberg Journal: Lancet Date: 2003-09-06 Impact factor: 79.321
Authors: Paul W Armstrong; Burkert Pieske; Kevin J Anstrom; Justin Ezekowitz; Adrian F Hernandez; Javed Butler; Carolyn S P Lam; Piotr Ponikowski; Adriaan A Voors; Gang Jia; Steven E McNulty; Mahesh J Patel; Lothar Roessig; Joerg Koglin; Christopher M O'Connor Journal: N Engl J Med Date: 2020-03-28 Impact factor: 91.245
Authors: Milton Packer; Michael B Fowler; Ellen B Roecker; Andrew J S Coats; Hugo A Katus; Henry Krum; Paul Mohacsi; Jean L Rouleau; Michal Tendera; Christoph Staiger; Terry L Holcslaw; Ildiko Amann-Zalan; David L DeMets Journal: Circulation Date: 2002-10-22 Impact factor: 29.690