title: Neurohormonal and clinical sex differences in heart failure.
abstract: OBJECTIVE
  Despite disparities in pathophysiology and disease manifestation between male and female patients with heart failure, studies focusing on sex differences in biomarkers are scarce. The purpose of this study was to assess sex-specific variation in clinical characteristics and biomarker levels to gain more understanding of the potential pathophysiological mechanisms underlying sex differences in heart failure.
  
  
  RESULTS
  Baseline demographic and clinical characteristics, multiple biomarkers, and outcomes were compared between men and women in 567 patients. The mean age of the study group was 71 ± 11 years and 38% were female. Women were older, had a higher body mass index and left ventricular ejection fraction, more hypertension, and received more diuretic and antidepressant therapy, but less ACE-inhibitor therapy compared with men. After 3 years, all-cause mortality was lower in women than men (37.0 vs. 43.9%, multivariable hazard ratio = 0.64; 95% confidence interval 0.45-0.92, P = 0.016). Levels of biomarkers related to inflammation [C-reactive protein, pentraxin 3, growth differentiation factor 15 (GDF-15), and interleukin 6] and extracellular matrix remodelling (syndecan-1 and periostin) were significantly lower in women compared with men. N-terminal pro-brain natriuretic peptide, TNF-αR1a, and GDF-15 showed the strongest interaction between sex and mortality.
  
  
  CONCLUSIONS
  Female heart failure patients have a distinct clinical presentation and better outcomes compared with male patients. The lower mortality was independent of differences in clinical characteristics, but differential sex associations between several biomarkers and mortality might partly explain the survival difference.
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, 9700 RB, Groningen, The Netherlands. s.meyer@umc.g.nl
authors.forename: Sven
authors.initials: S
authors.lastname: Meyer
authors.forename: Peter
authors.initials: P
authors.lastname: van der Meer
authors.forename: Vincent M
authors.initials: VM
authors.lastname: van Deursen
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Martje H L
authors.initials: MH
authors.lastname: van der Wal
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000451:nursing; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D018377:Neurotransmitter Agents / Q000378:metabolism*; D011379:Prognosis; D012727:Sex Characteristics
chemical_list: D015415:Biomarkers; D018377:Neurotransmitter Agents
keywords: Aetiology; Biomarkers; Heart failure; Mortality; Sex