Sex differences in cardiovascular outcome during progression of aortic valve stenosis.
Bottom Line: In multivariate analyses, female sex independently predicted less reduction in LV MWS and EF during follow-up (both p<0.05).AS event rate did not differ by sex.However, women had lower total mortality and ischaemic CV event rate than men independent of confounders.
Affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.Show MeSH
Related in: MedlinePlus
Mentions: During follow-up (median 4.0 years, IQR 3.0–4.2 years), a total of 554 major CV events occurred, among them 517 AS-related events and 260 ischaemic CV events. The ischaemic events included 56 strokes, 142 deaths from any cause (71 from CV causes), 28 non-fatal myocardial infarctions, 11 hospitalisations for unstable angina, 20 percutaneous coronary interventions and 142 coronary artery bypass revascularisations. Women had significantly lower risk of major CV events and ischaemic CV events (figure 3), also after adjustment for active study treatment, age and hypertension and time-varying ELI, low EF, low MWS and abnormal LV geometry in time-varying multivariate Cox analyses (table 4). Neither higher total cholesterol at baseline nor LDL cholesterol was associated with higher rate of ischaemic CV events when added to the time-varying Cox model run in the whole study population as well as separately in women and men. When current smoking at baseline was added to these models, the results remained unchanged. Analysing the association between sex and specific types of ischaemic CV events using similar Cox models, female sex predicted more than 50% lower rate of both stroke and coronary artery disease requiring concomitant bypass grafting at the time of aortic valve replacement (table 4). Women also had a 31% lower all-cause mortality rate independent of covariates (table 4 and figure 4). The annular incidence of ischaemic CV events was 3.4% in women and 4.4% in men (p<0.007).
Affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.