Wang, X. et al. (2023) Sex differences in clinical characteristics and outcomes after myocardial infarction with low ejection fraction: insights from PARADISE‐MI. Journal of the American Heart Association, 12(17), e028942. (doi: 10.1161/JAHA.122.028942) (PMID:37609931) (PMCID:PMC10547323)
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Abstract
Background: Studies demonstrated sex differences in outcomes following acute myocardial infarction, with women more likely to develop heart failure (HF). Sacubitril/valsartan has been shown to reduce cardiovascular death and HF hospitalizations in patients with HF with reduced ejection fraction. Methods and Results: A total of 5661 patients (1363 women [24%]) with acute myocardial infarction complicated by reduced left ventricular ejection fraction (≤40%), pulmonary congestion, or both and ≥1 of 8 risk‐augmenting factors were randomized to receive sacubitril/valsartan or ramipril. The primary outcome was cardiovascular death or incident HF. Baseline characteristics, clinical outcomes, and safety events were compared according to sex, a prespecified subgroup. Female participants were older and had more comorbidities. After multivariable adjustment, women and men were at similar risks for cardiovascular death or all‐cause death. Women were more likely to have first HF hospitalization (hazard ratio [HR], 1.34 [95% CI, 1.05–1.70]; P=0.02) and total HF hospitalizations (HR, 1.39 [95% CI, 1.05–1.84]; P=0.02). Sex did not significantly modify the treatment effect of sacubitril/valsartan compared with ramipril on the primary outcome (P for interaction=0.11). Conclusions: In contemporary patients who presented with reduced left ventricular ejection fraction, pulmonary congestion, or both, following acute myocardial infarction, women had a higher incidence of HF during follow‐up. Sex did not modify the treatment effect of sacubitril/valsartan relative to ramipril.
Item Type: | Articles |
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Additional Information: | PARADISE- MI (Prospective ARNI [Angiotensin Receptor–Neprilysin Inhibitor] Versus ACE [Angiotensin-Converting Enzyme] Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After Myocardial Infarction) was funded by Novartis. Dr X. Wang is supported by a T32 postdoctoral training grant from the National Heart, Lung, and Blood Institute (T32 HL094301) and by the Scott Schoen and Nancy Adams First.In.Women Cardiovascular Fellowship, Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital. Dr McMurray is sup-ported by a British Heart Foundation Centre of Research Excellence grant RE/18/6/34217. |
Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | McMurray, Professor John |
Authors: | Wang, X., Jering, K. S., Cikes, M., Tokmakova, M. P., Mehran, R., Han, Y., East, C., Mody, F. V., Wang, Y., Lewis, E. F., Claggett, B., McMurray, J. J. V., Granger, C. B., Pfeffer, M. A., and Solomon, S. D. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
Journal Name: | Journal of the American Heart Association |
Publisher: | Wiley |
ISSN: | 2047-9980 |
ISSN (Online): | 2047-9980 |
Published Online: | 23 August 2023 |
Copyright Holders: | Copyright © 2023 The Authors |
First Published: | First published in Journal of the American Heart Association 12(17):e028942 |
Publisher Policy: | Reproduced under a Creative Commons license |
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