Reversal of heart failure remodeling in women

Epidemiological studies suggest that women with heart failure differ from m en with heart failure in that their survival is better. Therapeutic trials have not clearly demonstrated a survival benefit for women. This study was to determine the tolerance for high doses of angiotensin-converting enzyme (ACE) inhibitor-nitrates in women versus men and to compare their symptomat ic response, exercise tolerance, and ventricular functional improvement ove r 1 year. Eighty-eight sequential patients with heart failure, 54 men and 3 4 women with left ventricular ejection fraction less than or equal to 35%, were prospectively followed for 1 year. For all patients, ACE inhibitor-nit rate therapy was intensified. Each patient had three 6-monthly echocardiogr ams at baseline, at 6 months, and at 1 year, and metabolic stress testing. Patients were 57.3 +/- 12.3 years old, with New York Heart Association (NYH A) class severity 2.6 +/- 1.0. Lisinopril dosages were raised from 14 +/- 1 4 mg/day to 57 +/- 26 mg/day, isosorbide mononitrate from 15 +/- 27 mg/day to 126 +/- 72 mg/day, and carvedilol (n = 34) to 17 +/- 16 mg/day. Women an d men were epidemiologically comparable, with similar baseline echocardiogr aphic parameters (left ventricular ejection fraction 19% +/- 7% versus 17% +/- 6%, respectively). Both tolerated up-titration in medical therapy. Fina l 12-month ejection fractions were equivalent for women and men at 34% +/- 17% and 34% +/- 13%, respectively, with similar improvements in left ventri cular diameters. At 1 year, women had higher resting heart rates and remain ed more symptomatic with lower exercise capacity. However, the relative cha nges in NYHA status and aerobic capacity were similar for women and men. Th us, both women and men tolerated uptitrated ACE inhibitor-nitrate medical t herapy, with comparable reversal of heart failure remodeling. Although wome n continued to be more symptomatic than men, relative improvements in sympt omatic status, in execise capacity, and in hospitalization rate were equiva lent.