title: Sex differences in clinical characteristics and prognosis in a broad spectrum of patients with heart failure: results of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program.
abstract: BACKGROUND
  We wished to test previous hypotheses that sex-related differences in mortality and morbidity may be due to differences in the cause of heart failure or in left ventricular ejection fraction (LVEF) by comparing fatal and nonfatal outcomes in women and men with heart failure and a broad spectrum of left ventricular ejection fraction.
  
  
  RESULTS
  We compared outcomes in 2400 women and 5199 men randomized in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program using multivariable regression analyses. A total of 1188 women (50%) had a low LVEF (< or = 0.40), and 1212 had a preserved LVEF (> 0.40). Among the men, 3388 (65%) had a low LVEF, and 1811 had a preserved LVEF. A total of 1216 women (51%) and 3465 men (67%) had an ischemic cause of their heart failure. All-cause mortality was 21.5% in women and 25.3% in men (adjusted hazard ratio [HR], 0.77; 95% CI, 0.69 to 0.86; P<0.001). Fewer women (30.4%) than men (33.3%) experienced cardiovascular death or heart failure hospitalization (adjusted HR, 0.83; 95% CI, 0.76 to 0.91; P<0.001). The risks of sudden death (HR, 0.70; 95% CI, 0.58 to 0.85) and death due to worsening heart failure (HR, 0.72; 95% CI, 0.58 to 0.89) were reduced to a comparable extent. The adjusted risk of cardiovascular hospitalization was also lower in women (HR, 0.88; 95% CI, 0.82 to 0.95), mainly because of a reduced risk of heart failure hospitalization (HR, 0.87; 95% CI, 0.78 to 0.97). Women had a lower risk of death irrespective of cause of heart failure or LVEF.
  
  
  CONCLUSIONS
  Among patients with heart failure, women have lower risks of most fatal and nonfatal outcomes that are not explained, as previously suggested, by LVEF or origin of the heart failure.
authors.affiliation: Western Infirmary, Glasgow, Scotland, UK.
authors.forename: Eileen
authors.initials: E
authors.lastname: O'Meara
authors.forename: Tim
authors.initials: T
authors.lastname: Clayton
authors.forename: Margaret B
authors.initials: MB
authors.lastname: McEntegart
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Ileana L
authors.initials: IL
authors.lastname: Piña
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: Jan
authors.initials: J
authors.lastname: Ostergren
authors.forename: Eric L
authors.initials: EL
authors.lastname: Michelson
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.forename: Stuart
authors.initials: S
authors.lastname: Pocock
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011379:Prognosis; D012307:Risk Factors; D012727:Sex Characteristics; D013318:Stroke Volume; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan