Research by the University Medical Center Groningen (UMCG) shows that the optimal doses of medication is considerably lower for women with heart failure than for men.
Worldwide, the recommended dosage of beta-blockers is similar for men and women with heart failure. ‘No is the time to further investigate the biological differences between men and women with heart failure’, say UMCG-researchers.
The results of the study are published in the British medical journal The Lancet.
Target values based on men's studies
More than 26 million – particularly older – people suffer from heart failure worldwide: a condition in which the heart is unable to sufficiently pump blood around the body, and often gets worse over time. Heart failure can be treated with various medications, which have to be slowly up-titrated to optimal dose levels. These dose levels are recommended by international heart failure guidelines. However, in the past decades, mostly men (80% or more) participated in the major studies on which these guidelines are based. These studies did not take sex differences into account.
In 2009, the UMCG received a 12 million euro grant for conducting a major international study to investigate the effectiveness of heart failure medication. Between 2010 and 2015, data was collected from 2,500 people from Europe. Together with data from more than 4,500 heart failure patients from Asia, physician-scientist Bernadet Santema (28) investigated the use of beta-blockers and the combined group of ACE-inhibitors/ARBs (angiotensin-receptor blockers), and zoomed in on the differences between men and women.
Optimal doses for women 50% lower
The data analysis now shows that women with heart failure benefit from lower doses of the drugs under study. The optimal doses for women appear to be around 50% of the doses that are currently recommended. The researchers underline that this conclusion should not be misinterpreted as an excuse to undertreat women with heart failure. More research is needed to examine how differences between men and women can influence the treatment of heart failure. For example, we already know that differences in body size and weight, proportion of body fat, and circulating blood volume can influence the effect and optimal doses of medication, and it is known that women suffer from serious side effects more often than men.
More research into gender differences
The research by Santema and her colleagues emphasizes the importance of more research into sex differences. Professor Adriaan Voors, cardiologist and head of UMCG’s outpatient clinic: ‘Looking back, it is remarkable that medical sciences have paid so little attention to the differences between men and women for decades, while it is so obvious that there are many differences. Sometimes the biggest breakthroughs arise from very simple questions. The result we have found, could very well apply to many more disease areas.’
The European study was performed in collaboration with, among others, the University of Leicester, the University of Dundee, Imperial College London, and the University of Glasgow.