Long-Term Prognosis in Women vs Men With Pulmonary Arterial Hypertension
Women with PAH had greater improvement in RV end-diastolic pressure, right atrial pressure, cardiac index, and mixed venous oxygen saturation.
Women with pulmonary arterial hypertension (PAH) experienced better long-term prognosis than men with PAH, a finding that may be partially driven by greater improvements in right ventricular function and hemodynamics, according to a study published in Heart and Vessels.
A total of 129 consecutive patients with PAH were included in this analysis, of whom 34 were men and 95 were women. Investigators compared long-term prognosis and hemodynamic improvements in response to PAH-targeted treatment among men and women. Targeted PAH therapy included intravenous and oral prostacyclin analogs, endothelin-receptor antagonists, and phosphodiesterase type-5 (PDE-5) inhibitors.
Overall, a greater proportion of female patients with PAH experienced greater 5-year survival than male patients (74.0% vs 53.4%, respectively; P =.003). Targeted PAH therapy was associated with significant decreases in mean pulmonary vascular resistance, pulmonary arterial capacitance, and pulmonary arterial pressure in both groups of patients at follow-up (both P <.05).
Despite these benefits, women had greater improvement in right ventricular end-diastolic pressure, right atrial pressure, cardiac index, and mixed venous oxygen saturation (all P <.05). In addition, treatment with PDE-5 inhibitors (hazard ratio [HR], 0.45; 95% CI, 0.22-0.89; P =.02) or endothelin-receptor antagonists (HR, 0.42; 95% CI, 0.21–0.87; P =.02) was associated with significantly better prognosis in women only. Conversely, age ≥60 years was associated with worse prognosis in women (HR, 5.25; 95% CI, 1.77-19.50; P =.0022).
Because this study was performed at a single center, it is possible that there was selection bias. In addition, the investigators noted that long-term survivors were more likely to have been treated with newer drugs during follow-up, which may have further affected the 5-year prognosis.
The investigators suggested that future development of “individual treatment may ameliorate long-term prognosis of [patients with] PAH.”
Kozu K, Sugimura K, Aoki T, et al. Sex differences in hemodynamic responses and long-term survival to optimal medical therapy in patients with pulmonary arterial hypertension [published online February 13, 2018]. Heart Vessels. doi:10.1007/s00380-018-1140-6