Gender and survival in patients with heart failure: interactions with diabetes and aetiology. Results from the MAGGIC individual patient meta-analysis
Gender and survival in patients with heart failure: interactions with diabetes and aetiology. Results from the MAGGIC individual patient meta-analysis
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DOI：
10.1093/eurjhf/hfs026
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发表时间：
2012-05-01
影响因子：
18.2
通讯作者：
Squire, Iain
中科院分区：
文献类型：
--
作者：
Martinez-Selles, Manuel;Doughty, Robert N.;Squire, Iain
这项研究的目的是利用随机试验和观察性研究的数据，以及年龄、左心室收缩功能、病因学和糖尿病对男性和女性预后差异的相对贡献，调查性别与心力衰竭患者存活率的关系。数据来自Meta-分析全球慢性心力衰竭小组(MAGGIC)的31项研究(41 949名患者；28 052名男性，13 897名女性)。我们进行了生存分析，以评估性别与死亡率的关系，调整了死亡率的预测因素，包括年龄、减少或保留的射血分数(EF)以及缺血性或非缺血性病因。与男性相比，女性年龄更大[70.5(标准差12.1)比65.6(标准差11.6)岁]，更有可能有高血压史(49.9比40.0)，更不可能有缺血性心脏病史(46.3比58.7)和EF降低(62.6比81.6)。在3年的随访中，3521(25)名女性和7232(26)名男性死亡。调整后，男性是死亡率的独立预测因子，与非缺血性心力衰竭患者和非糖尿病患者相比，非缺血性心力衰竭患者与女性相关的预后更好(交互作用P值为0.0001)。这项大型的个体患者数据荟萃分析表明，与EF无关，患有心力衰竭的女性患者的存活率比男性更好。这种生存益处在非缺血性心力衰竭中略显着，但会因伴随的糖尿病而减弱。
The aim of this study was to investigate the relationship between gender and survival of patients with heart failure, using data from both randomized trials and observational studies, and the relative contribution of age, left ventricular systolic function, aetiology, and diabetes to differences in prognosis between men and women.Data from 31 studies (41 949 patients; 28 052 men, 13 897 women) from the Meta-Analysis Global Group In Chronic Heart Failure (MAGGIC) individual patient meta-analysis were used. We performed survival analysis to assess the association of gender with mortality, adjusting for predictors of mortality, including age, reduced or preserved ejection fraction (EF), and ischaemic or non-ischaemic aetiology. Women were older [70.5 ( standard deviation 12.1) vs. 65.6 (standard deviation 11.6) years], more likely to have a history of hypertension (49.9 vs. 40.0), and less likely to have a history of ischaemic heart disease (46.3 vs. 58.7) and reduced EF (62.6 vs. 81.6) compared with men. During 3 years follow-up, 3521 (25) women and 7232 (26) men died. After adjustment, male gender was an independent predictor of mortality, and the better prognosis associated with female gender was more marked in patients with heart failure of non-ischaemic, compared with ischaemic, aetiology (P-value for interaction 0.03) and in patients without, compared with those with, diabetes (P-value for interaction 0.0001).This large, individual patient data meta-analysis has demonstrated that survival is better for women with heart failure compared with men, irrespective of EF. This survival benefit is slightly more marked in non-ischaemic heart failure but is attenuated by concomitant diabetes.