Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy

Iacopo Olivotto, Martin S. Maron, A. Selcuk Adabag, Susan A. Casey, Daniela Vargiu, Mark S. Link, James E. Udelson, Franco Cecchi, Barry J. Maron

Research output: Contribution to journalArticle

171 Citations (Scopus)

Abstract

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 ≥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.

Original languageEnglish (US)
Pages (from-to)480-487
Number of pages8
JournalJournal of the American College of Cardiology
Volume46
Issue number3
DOIs
StatePublished - Aug 2 2005

Fingerprint

Hypertrophic Cardiomyopathy
Sudden Death
Italy
Heart Failure
Stroke
Ventricular Outflow Obstruction
Mortality
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy. / Olivotto, Iacopo; Maron, Martin S.; Adabag, A. Selcuk; Casey, Susan A.; Vargiu, Daniela; Link, Mark S.; Udelson, James E.; Cecchi, Franco; Maron, Barry J.

In: Journal of the American College of Cardiology, Vol. 46, No. 3, 02.08.2005, p. 480-487.

Research output: Contribution to journalArticle

Olivotto, I, Maron, MS, Adabag, AS, Casey, SA, Vargiu, D, Link, MS, Udelson, JE, Cecchi, F & Maron, BJ 2005, 'Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy', Journal of the American College of Cardiology, vol. 46, no. 3, pp. 480-487. https://doi.org/10.1016/j.jacc.2005.04.043
Olivotto, Iacopo ; Maron, Martin S. ; Adabag, A. Selcuk ; Casey, Susan A. ; Vargiu, Daniela ; Link, Mark S. ; Udelson, James E. ; Cecchi, Franco ; Maron, Barry J. / Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy. In: Journal of the American College of Cardiology. 2005 ; Vol. 46, No. 3. pp. 480-487.
@article{2a934906616d4e94b015d330a00eb28f,
title = "Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy",
abstract = "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 ≥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.",
author = "Iacopo Olivotto and Maron, {Martin S.} and Adabag, {A. Selcuk} and Casey, {Susan A.} and Daniela Vargiu and Link, {Mark S.} and Udelson, {James E.} and Franco Cecchi and Maron, {Barry J.}",
year = "2005",
month = "8",
day = "2",
doi = "10.1016/j.jacc.2005.04.043",
language = "English (US)",
volume = "46",
pages = "480--487",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "3",

}

TY - JOUR

T1 - Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy

AU - Olivotto, Iacopo

AU - Maron, Martin S.

AU - Adabag, A. Selcuk

AU - Casey, Susan A.

AU - Vargiu, Daniela

AU - Link, Mark S.

AU - Udelson, James E.

AU - Cecchi, Franco

AU - Maron, Barry J.

PY - 2005/8/2

Y1 - 2005/8/2

N2 - 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 ≥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.

AB - 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 ≥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.

UR - http://www.scopus.com/inward/record.url?scp=22844452302&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=22844452302&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2005.04.043

DO - 10.1016/j.jacc.2005.04.043

M3 - Article

C2 - 16053962

AN - SCOPUS:22844452302

VL - 46

SP - 480

EP - 487

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 3

ER -