Girls with HF typically have a better illness burden they usually have been proven to learn much less from therapy with sodium-glucose cotransporter-2 (SGLT2) inhibitors, of which dapagliflozin is one. Nevertheless, this class has additionally confirmed itself lately as “a invaluable therapy for HFrEF, and it’s clearly vital to look at the results of this remedy in girls in addition to males with HFrEF,” the authors famous.
The 4744 sufferers included on this evaluation (23.4% girls), with a main consequence of worsening HF (eg, hospitalization or pressing go to with intravenous remedy) or cardiovascular loss of life, had New York Coronary heart Affiliation practical class II by means of IV illness and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) ranges. They had been randomized to an addition of both 10-mg one-daily dapagliflozin or placebo.
Dapagliflozin was proven to equally reduce the chance of worsening HF occasions or CV loss of life in women and men:
- Males gained a 27% lesser threat (HR, 0.73; 95% CI, 0.63-0.85)
- Girls gained a 21% lesser threat (HR, 0.79; 95% CI, 0.59-1.06; P interplay = .67)
The SGLT2 inhibitor additionally resulted in there being extra sufferers with significant symptom enchancment and fewer with worsening signs vs placebo, respectively, as measured by the Kansas Metropolis Cardiomyopathy Questionnaire complete symptom rating:
- Whole symptom rating enchancment of > 5 factors:
- Girls: 57% vs 54%
- Males 59% vs 50% (Pinterplay = .14)
- Symptom rating lower of > 5 factors:
- Girls: 27% vs 31%
- Males: 25% vs 34% (Pinterplay = .15)
Therapy discontinuation and the speed of significant antagonistic occasions, too, had been constant among the many males (imply [SD] age, 65.9 [10.9] years) and girls (imply age, 67.6 [10.7] years).
The ladies within the research tended to be older and Black. Additionally they had a lesser probability of atrial fibrillation, power obstructive pulmonary illness, and anemia, however a better probability of getting greater systolic blood stress, coronary heart fee, and baseline NT-proBNP.
Analyses additionally discovered:
- 28% decrease threat of worsening HF or CV loss of life in girls (adjusted HR, 0.72; 95% CI, 0.61-0.85) vs males
- 20% decrease threat of HF hospitalization or CV loss of life in girls (HR, 0.80; 95% CI, 0.59-1.08)
- 27% decrease threat of HF hospitalization or CV loss of life in males (HR, 0.73; 95% CI, 0.63-0.85)
- 31% decrease threat of hospitalizations in males (HR, 0.69; 95% CI, 0.57-0.84)
- 27% decrease threat of hospitalizations in girls (HR, 0.73; 95%, 0.51-1.06)
- 16% decrease threat of CV loss of life in males (HR, 0.84; 95% CI, 0.69-1.02)
- 24% decrease threat of CV loss of life in girls (HR, 0.76; 95% CI, 0.49-1.16)
As well as, systolic blood stress equally decreased in each affected person teams. On the 4-month mark, this amounted to –1.69 mm Hg (95% CI, –3.37 to –0.02) for the ladies and –1.88 mm Hg (95% CI, –2.80 to –0.96) for the lads.
“Dapagliflozin decreased the chance of worsening HF, cardiovascular loss of life, and all-cause loss of life and improved signs, bodily operate, and health-related high quality of life equally in women and men with coronary heart failure and decreased ejection fraction,” the authors concluded. “Collectively, these information present additional assist for dapagliflozin as a brand new therapy possibility for HFrEF.”
Importantly, the authors spotlight that their discovering ought to supply reassurance that dapagliflozin is tolerable and secure to be used amongst sufferers with HFrEF, ladies and men.
Butt JH, Docherty KF, Petrie MC, et al. Efficacy and security of dapagliflozin in women and men with coronary heart failure with decreased ejection fraction: a prespecified evaluation of the dapagliflozin and prevention of antagonistic outcomes in coronary heart failure trial. JAMA Cardiol. Printed on-line March 31, 2021. doi:10.1001/jamacardio.2021.0379