title: Sex differences in cardiovascular outcome during progression of aortic valve stenosis.
abstract: OBJECTIVE
  Women with severe aortic valve stenosis (AS) have better LV systolic function and more concentric LV geometry than their male counterparts. However, sex differences in cardiovascular (CV) outcome during progression of AS have not been reported from a longitudinal prospective study.
  
  
  METHODS
  Doppler echocardiography and CV events were recorded during a median of 4.0 years in 979 men and 632 women aged 28-86 (mean 67±10) years in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study. LV systolic function was assessed by EF and midwall shortening (MWS). Study outcomes were AS-related events, ischaemic CV events and total mortality.
  
  
  RESULTS
  The annular cumulative incidence of AS events, ischaemic CV events and death was 8.1%, 3.4% and 2.8% in women, and 8.9%, 4.4% and 2.4% in men, respectively. Women and men had similar AS progression rate whether measured by peak jet velocity, mean gradient or valve area. In multivariate analyses, female sex independently predicted less reduction in LV MWS and EF during follow-up (both p<0.05). In time-varying Cox analyses, women had a 40% lower rate of ischaemic CV events (95% CI 21% to 54%), in particular, more than 50% lower rate of stroke and coronary artery bypass grafting, and a 31% lower all-cause mortality (95% CI 1% to 51%), independent of active study treatment, age and hypertension, as well as time-varying valve area, low systolic function and abnormal LV geometry. AS event rate did not differ by sex.
  
  
  CONCLUSIONS
  In the SEAS study, women and men had similar rates of AS progression and AS-related events. However, women had lower total mortality and ischaemic CV event rate than men independent of confounders.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00092677.
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
authors.forename: Dana
authors.initials: D
authors.lastname: Cramariuc
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Barbara Patricia
authors.initials: BP
authors.lastname: Rogge
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Mai Tone
authors.initials: MT
authors.lastname: Lønnebakken
authors.affiliation: Research unit, Medicine, Umeaa University, Skellefteaa, Sweden.
authors.forename: Kurt
authors.initials: K
authors.lastname: Boman
authors.affiliation: Asklepios Clinic St. Georg, Hamburg, Germany.
authors.forename: Edda
authors.initials: E
authors.lastname: Bahlmann
authors.affiliation: Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Christa
authors.initials: C
authors.lastname: Gohlke-Bärwolf
authors.affiliation: Guy's and St Thomas Hospitals, London, UK.
authors.forename: John B
authors.initials: JB
authors.lastname: Chambers
authors.affiliation: Department of Preventive Cardiology, Ullevål University Hopital, Oslo, Norway.
authors.forename: Terje R
authors.initials: TR
authors.lastname: Pedersen
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Eva
authors.initials: E
authors.lastname: Gerdts
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011379:Prognosis; D017678:Sex Distribution; D012737:Sex Factors; D019821:Simvastatin / Q000627:therapeutic use*; D015996:Survival Rate / Q000639:trends; D013599:Systole; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin