RAAS inhibitors reduced all-cause mortality more in men (HR 0.77) than women (HR 0.87) with heart failure, with no mortality benefit in women with HFrEF.
Does RAASi therapy reduce all-cause mortality differently in men versus women with heart failure?
RAASi therapy reduces all-cause mortality in heart failure, but the benefit is significantly less pronounced in women, particularly in HFrEF where women showed no mortality benefit compared to men.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Renin–angiotensin–aldosterone system inhibitors (RAASi) are a cornerstone in heart failure (HF) management, consistently demonstrating mortality benefits. However, the differential impact of RAASi therapy on mortality between men and women remains underexplored. This study investigates gender-specific outcomes associated with RAASi use in HF patients. Purpose To evaluate the gender-specific impact of RAASi therapy on all-cause mortality in HF patients. Methods A retrospective cohort study was conducted on HF patients treated between January 2014 and August 2024 at a single tertiary center. Patients were categorized by gender and RAASi use. The primary outcome was all-cause mortality. Cox proportional hazards models were applied to assess mortality risk, adjusted for age and established comorbidities. Inverse probability treatment weighting (IPTW) was used to account for confounders. Ethical approval was obtained from the Institutional Review Board. Results The cohort included 21,809 HF patients (median age 74±14 years), of whom 9,040 (41%) were women and 12,482 (57%) were RAASi users. During a median follow-up of 3.5±3 years, 10,168 (46%) patients died. RAASi use was associated with a significant reduction in all-cause mortality in both men (HR 0.77, 95% CI 0.71–0.83, p 0.001) and women, though the effect was less pronounced in women (HR 0.87, 95% CI 0.81–0.95, p 0.01; p interaction 0.01). In the IPTW pseudo-population, which included 10,590 women and 12,722 men with equal proportions of RAASi users (50% in each group) and balanced covariates, including HTN, the trend remained consistent. Women experienced a less pronounced reduction (HR 0.87, 95% CI 0.94–1.15, p 0.01) compared to men (HR 0.77, 95% CI 0.71–0.83, p 0.01). In HF with reduced ejection fraction (HFrEF), RAASi use showed no benefit among women (HR 1.02, 95% CI 1.15–1.41, p= 0.52) compared to men (HR 0.67, 95% CI 0.58–0.78, p 0.01, p-interaction 0.01). This trend was not observed among patients with HF with preserved ejection fraction (HFpEF), showing no difference between the sexes. Conclusion(s) RAASi therapy significantly reduces all-cause mortality in HF patients, with men deriving a greater benefit than women. These findings highlight the importance of gender-specific considerations in HF management.Adjusted IPTW Kaplan Meier RAASi Men Adjusted IPTW Kaplan Meier RAASi Women
Copeland et al. (Sat,) reported a other. RAAS inhibitors reduced all-cause mortality more in men (HR 0.77) than women (HR 0.87) with heart failure, with no mortality benefit in women with HFrEF.