Study: Among Heart Failure Patients, Women Survive Twice As Long As Men

April 12, 1999

CHAPEL HILL -- For still unknown reasons, women with advanced congestive heart failure survive twice as long as men with the same life-threatening condition, according to a new study. The increased life expectancy among women cannot be attributed to differences between the sexes in medical treatment, the research shows.

Congestive heart failure, in which the weakened heart cannot pump enough blood to meet the body's oxygen needs, is the only kind of cardiovascular disease increasing steadily in the U.S. population. It affects an estimated 4.6 million Americans.

A report on the research, conducted at the University of North Carolina at Chapel Hill and elsewhere, appears in the April 13 issue of the American Heart Association journal Circulation.

Authors include lead scientist Dr. Kirkwood F. Adams Jr., associate professor of medicine and radiology; Dr. Carla A. Sueta, assistant professor of medicine, graduate student Todd A. Schwartz; and Dr. Gary G. Koch, professor of biostatistics, all of UNC-CH.

"Our analysis suggests that the trend for increased survival is strongest among a subset of patients - those with congestive heart failure that is not due to ischemia, or lack of blood supply to the heart," said Adams, also director of the School of Medicine's heart failure program.

Ischemic heart failure results from fatty plaque deposits building up in arteries supplying the heart with oxygen and reducing blood flow just as rust in old pipes cuts water flow, the physician said. High blood pressure and other conditions that weaken heart muscle cause a related illness known as non-ischemic heart failure.

Adams and his colleagues tapped data from the Flolan International Randomized Survival Trial (FIRST) to analyze and compare 331 men and 99 women with advanced heart failure. They adjusted for age, gender, medications such as the commonly used dobutamine, physical condition and other factors.

Researchers found that:
    Men with ischemic heart failure were 1.5 times more likely than women to die during the first 18 months of treatment.

    Men with non-ischemic heart failure were three times more likely to die during that period.

    Among patients with congestive heart failure, men more often than women tended to be white.

    Atherosclerosis, or "hardening of the arteries," caused heart failure in men more commonly than in women.

    As a group, men tended to have less severe clinical evidence of heart failure than women.

"Several unique aspects of the FIRST study population enhance the likelihood that biological differences are an important cause of the survival difference we observed between males and females," Adams said. "A growing body of evidence points to fundamental gender-related differences in the nature and extent of heart failure."

More studies are needed to pinpoint why the survival differences exist, he said. Such information might help boost survival for both sexes, and for men in particular.

Others involved in the study were Drs. Mihai Gheorghiade of Northwestern University, Christopher M. O'Connor and Robert M. Califf of Duke University, Barry Utretsky of the University of Texas Medical Branch in Galveston, Karl Swedberg of Ostra University Hospital in Sweden, William McKenna of St. George's Hospital Medical School in London and Jordi Soler-Soler of Vall D'Hebron University Hospital in Barcelona, Spain.
Contact: David Williamson
Note: Adams can be reached at 919-966-4445.

University of North Carolina at Chapel Hill

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