Brief observationSex-related differences in the use and adverse effects of angiotensin-converting enzyme inhibitors in heart failure: the study of patients intolerant of converting enzyme inhibitors registry☆
Section snippets
Material and methods
The SPICE registry catalogued demographic and clinical information on patients with left ventricular dysfunction between August 1996 and April 1997. The registry (3) was part of the SPICE trial, which evaluated the efficacy of candesartan cilexetil in patients with chronic heart failure who were unable to tolerate ACE inhibitors (4).
Patients who had undergone recent invasive or noninvasive left ventricular assessment were candidates for the registry. Investigators retrospectively reviewed
Results
Investigators recruited 9,580 patients into the registry. Patients who were missing the variable “age” or who had an unknown or indeterminate NYHA class were excluded. The final sample included 9,210 patients, of whom 2,421 (26.3%) were women. Women were significantly older than men and had significantly higher systolic pressures (Table 1). Left ventricular ejection fractions and serum creatinine levels were similar in men and women. Approximately 90% of patients had symptomatic heart failure.
Discussion
The SPICE registry shows that ACE inhibitors are commonly prescribed for both men and women with heart failure but that women are less likely to receive sustained therapy with these drugs. One reason may have been that women in the registry were older; physicians have tended to underuse ACE inhibitors in older patients 5, 6. Even after adjustment for age, however, women were still less likely to be treated with ACE inhibitors, as has been observed in earlier studies 5, 6, 7.
The lesser use of
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2021, European Journal of PharmacologyCitation Excerpt :ARNIs have only been available for the past five years, therefore it is not currently clear whether there are sex-related differences in their prescription rates. While the reasons for sex-related differences in prescription rates remain largely unresolved, scholars have postulated that one of the reasons for less frequent prescriptions of these drugs in women may be due to an increased rate of adverse effects in women (Kostis et al., 1996; Petrie et al., 1999; Shah et al., 2000). Dry cough, the most common reason for intolerance to ACEIs leading to their discontinuation, has been reported to be more frequent in women (Gibson 1989; Os et al., 1992; Mackay et al., 1999).
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Supported by a grant from AstraZeneca, Wayne, Pennsylvania, and Mölndal, Sweden.