(Circulation. 2001;103:375.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Sex Differences in the Prognosis of Congestive Heart Failure
Results From the Cardiac Insufficiency Bisoprolol Study (CIBIS II)
From the Departments of Pharmacology (T.S., C.F.-B., P.J.) and Biostatistics (M.M.-K.), INSERM SC4, Paris VI University, Saint Antoine University Hospital, Rue Chaligny, Paris, France.
Correspondence to Dr Tabassome Simon, Pharmacology Department, Saint Antoine University, 27 Rue Chaligny, 75012 Paris, France. E-mail tabassome.simon{at}chusa.jussieu.fr
Background—Whether female sex is associated with a better prognosis in patients with congestive heart failure (CHF) remains uncertain. The Cardiac Insufficiency Bisoprolol Study (CIBIS) II showed that bisoprolol reduced all-cause mortality and morbidity rates in CHF patients treated with diuretics and ACE inhibitors. We examined whether survival was different in men (n=2132) and women (n=515) enrolled in CIBIS II.
Methods and Results—Women differed from men with regard to age, NYHA functional classification, primary cause of CHF, and risk factors such as left bundle-branch block. After adjustment for baseline differences, the probability of all-cause mortality was significantly reduced by 36% in women compared with that in men (hazard ratio 0.64, 95% CI 0.47 to 0.86, P=0.003). Women also had a 39% reduction in cardiovascular deaths (hazard ratio 0.64, 95% CI 0.45 to 0.91, P=0.01) and a 70% reduction in deaths from pump failure (hazard ratio 0.30, 95% CI 0.13 to 0.70, P=0.005) compared with men. Kaplan-Meier survival analysis revealed a significant reduction in all-cause mortality among women treated with bisoprolol compared with men (6% versus 12% P=0.01) but not among women treated with placebo (13% versus 18%, P=0.10). However, this sex/ß-blocker effect was not significant in multivariate analysis.
Conclusions—These results indicate that regardless of ß-blocker treatment and baseline clinical profile, female sex is a significant independent predictor of survival in patients with CHF.
Key Words: sex • women • heart failure • trials • antiarrhythmia agents
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