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Female gender confers a survival advantage in heart failure (HF), but it is unclear whether characteristics such as obesity or coronary artery disease (CAD) underlie this favorable mortality for females.
We identified 4334 patients (26.6% female) with systolic HF who underwent cardiopulmonary testing 1995 to 2011. A multivariable Cox proportional hazard model was constructed to examine associations between gender, CAD status, BMI, other baseline characteristics and all-cause mortality.
Compared to males, females were younger (52.2±12.3 vs 54.4±11.9), lower in BMI (27.8±6.3 vs 28.6±5.3 kg/m2), had higher ejection fractions (22.8±9.1 vs 21.6±8.7%) and lower CAD prevalence (28.1 vs 54.8%), all p<0.0001. Unadjusted mortality at 81.6±59 months was 39.1% (32.0 females vs 41.7% males, p<0.0001). After adjustment for demographics, comorbidities, drugs and VO2 max (overall model γ2 725.5), there was a significant interaction between gender and CAD status (γ2 23.5, p<0.0001) as illustrated by Figure 1. Figure 2illustrates the weaker interaction between gender and BMI (γ2 3.10, p=0.078), whereby increasing BMI associates with increased adjusted mortality risk in males, but not females, with systolic HF.
The protective effect of female gender on adjusted mortality in systolic HF is absent in females with CAD. Lower CAD prevalence and possibly less negative impact of adiposity in females with HF are two mechanisms by which females may attain a survival advantage.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Epidemiology, Risk Modeling and Prediction of Outcomes in Heart Failure
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1308-289
- 2013 American College of Cardiology Foundation