Why the study?
Little is known regarding the impact of gender on the heterogeneous clinical profile and clinical course of hypertrophic cardiomyopathy.
Does female gender increase the risk of adverse clinical outcomes in patients with hypertrophic cardiomyopathy?
Cohort (n=969)
Yes
Does female gender increase the risk of adverse clinical outcomes in patients with hypertrophic cardiomyopathy?
Hazard Ratio: 1.5
p-value: p=<0.001
Women with hypertrophic cardiomyopathy present at an older age, are more symptomatic, and have a higher risk of progression to advanced heart failure or death compared to men.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Women often tell me, 'I've been dealing with these symptoms all this time and I can't tell you how many doctors have made me feel like I was out of my mind, made it up, or it's actually anxiety.' Yet no one assessed these women for potential cardiac conditions like HCM.”
“Compared with men, women derived similar and sustained long-term benefit from mavacamten, including reduced need for septal reduction therapy, improvements in symptoms and quality of life, and favorable cardiac remodeling. Moreover, women derived these benefits without additional safety concerns.”
Gender differences may affect HCM presentation; hypothesis-generating for tailored evaluation and outcomes.
OBJECTIVES: The goal of this study was to assess gender-related differences in a multicenter population with hypertrophic cardiomyopathy (HCM). BACKGROUND: Little is known regarding the impact of gender on the heterogeneous clinical profile and clinical course of HCM. METHODS: We studied 969 consecutive HCM patients from Italy and the U.S. followed over 6.2 +/- 6.1 years. RESULTS: Male patients had a 3:2 predominance (59%), similar in Italy and the U.S. (p = 0.24). At initial evaluation, female patients were older and more symptomatic than male patients (47 +/- 23 years vs. 38 +/- 18 years; p < 0.001; mean New York Heart Association [NYHA] functional class 1.8 +/- 0.8 vs. 1.4 +/- 0.6; p < 0.001), and more frequently showed left ventricular outflow obstruction (37% vs. 23%; p < 0.001). Moreover, female patients were less often diagnosed fortuitously by routine medical examination (23% vs. 41% in male patients, p < 0.001). Female gender was independently associated with the risk of symptom progression to NYHA functional classes III/IV or death from heart failure or stroke compared with male gender (independent relative hazard 1.5; p < 0.001), particularly patients > or =50 years of age and with resting outflow obstruction (p < 0.005). Hypertrophic cardiomyopathy-related mortality and risk of sudden death were similar in men and women. CONCLUSIONS: Women with HCM were under-represented, older, and more symptomatic than men, and showed higher risk of progression to advanced heart failure or death, often associated with outflow obstruction. These gender-specific differences suggest that social, endocrine, or genetic factors may affect the diagnosis and clinical course of HCM. A heightened suspicion for HCM in women may allow for timely implementation of treatment strategies, including relief of obstruction and prevention of sudden death or stroke.
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Olivotto et al. (2005) conducted a cohort in Hypertrophic cardiomyopathy (HCM) (n=969). Female gender vs. Male gender was evaluated on Symptom progression to NYHA functional classes III/IV or death from heart failure or stroke (HR 1.5, p=<0.001).
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