Sex differences in clinical characteristics and outcomes after myocardial infarction: insights from the Valsartan in Acute Myocardial Infarction Trial (VALIANT)

TY - JOUR

T1 - Sex differences in clinical characteristics and outcomes after myocardial infarction

T2 - insights from the Valsartan in Acute Myocardial Infarction Trial (VALIANT)

AU - Lam, Carolyn S P

AU - McEntegart, Margaret

AU - Claggett, Brian

AU - Liu, Jiankang

AU - Skali, Hicham

AU - Lewis, Eldrin

AU - Køber, Lars

AU - Rouleau, Jean

AU - Velazquez, Eric

AU - Califf, Rob

AU - McMurray, John J

AU - Pfeffer, Marc

AU - Solomon, Scott

N1 - © 2015 The Authors. European Journal of Heart Failure © 2015 European Society of Cardiology.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Background We examined the association of sex with clinical characteristics and outcomes in patients following myocardial infarction (MI) in the Valsartan in Acute Myocardial Infarction Trial (VALIANT). Methods and Results A total of 4570 women and 10 133 men with heart failure (HF), left ventricular systolic dysfunction or both were enrolled 0.5-10 days after myocardial infarction (MI) and followed for a median of 24.7 months. Compared with men, women were older, had more comorbidities, and were more likely to present in Killip Class III/IV and experience post-infarction angina or HF. After adjusting for baseline differences, both short-term and longer-term mortality were similar in men and women. However, women were more likely than men to experience the composite outcome of cardiovascular death, MI, HF, stroke, and resuscitation from cardiac arrest [adjusted hazard ratio (HR) 1.15; 95% confidence interval (CI); 1.06-1.24, P = 0.001], mainly owing to an increased risk of hospitalization for HF (adjusted HR 1.36; 95% CI 1.22-1.52; P < 0.001). In a subset of patients who underwent echocardiographic study (n = 603), women had smaller left ventricular volumes indexed by body size than men but similar ejection fractions and similar changes in ventricular volumes from baseline to 1 month and 20 months. Conclusions In VALIANT, the risk of HF following MI was higher in women than men after adjusting for age and comorbidities, although the risk of other fatal and non-fatal outcomes were similar. The higher long-term risk of HF in women appears to be independent of the extent of left ventricular systolic dysfunction or remodelling compared with men.

AB - Background We examined the association of sex with clinical characteristics and outcomes in patients following myocardial infarction (MI) in the Valsartan in Acute Myocardial Infarction Trial (VALIANT). Methods and Results A total of 4570 women and 10 133 men with heart failure (HF), left ventricular systolic dysfunction or both were enrolled 0.5-10 days after myocardial infarction (MI) and followed for a median of 24.7 months. Compared with men, women were older, had more comorbidities, and were more likely to present in Killip Class III/IV and experience post-infarction angina or HF. After adjusting for baseline differences, both short-term and longer-term mortality were similar in men and women. However, women were more likely than men to experience the composite outcome of cardiovascular death, MI, HF, stroke, and resuscitation from cardiac arrest [adjusted hazard ratio (HR) 1.15; 95% confidence interval (CI); 1.06-1.24, P = 0.001], mainly owing to an increased risk of hospitalization for HF (adjusted HR 1.36; 95% CI 1.22-1.52; P < 0.001). In a subset of patients who underwent echocardiographic study (n = 603), women had smaller left ventricular volumes indexed by body size than men but similar ejection fractions and similar changes in ventricular volumes from baseline to 1 month and 20 months. Conclusions In VALIANT, the risk of HF following MI was higher in women than men after adjusting for age and comorbidities, although the risk of other fatal and non-fatal outcomes were similar. The higher long-term risk of HF in women appears to be independent of the extent of left ventricular systolic dysfunction or remodelling compared with men.

KW - Aged

KW - Angiotensin II Type 1 Receptor Blockers

KW - Angiotensin-Converting Enzyme Inhibitors

KW - Captopril

KW - Drug Therapy, Combination

KW - Echocardiography

KW - Female

KW - Heart Failure

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Risk

KW - Risk Factors

KW - Sex Factors

KW - Valsartan

KW - Ventricular Dysfunction, Left

U2 - 10.1002/ejhf.238

DO - 10.1002/ejhf.238

M3 - Journal article

C2 - 25655011

SN - 1567-4215

VL - 17

SP - 301

EP - 312

JO - European Journal of Heart Failure, Supplement

JF - European Journal of Heart Failure, Supplement

IS - 3

ER -