DOI: 10.1161/jaha.125.046708 ISSN: 2047-9980

Sex Differences in Characteristics and Outcomes Among Patients With Hypertrophic Cardiomyopathy: Insights From the REVEAL‐HCM Study

Masayuki Nakamura, Haruhiko Abe, Yasunori Ueda, Hiroaki Kitaoka, Yasushi Sakata, Kaoru Dohi, Yukichi Tokita, Takao Kato, Shouji Matsushima, Masashi Amano, Takeshi Kitai, Atsushi Okada, Yutaka Furukawa, Toshihiro Tamura, Akihiro Hayashida, Kenji Ando, Satoshi Yuda, Moriaki Inoko, Kazushige Kadota, Yukio Abe, Katsuomi Iwakura, Tetsuya Kitamura, Jun Masuda, Takahiro Ohara, Takashi Omura, Takashi Tanigawa, Kenji Nakamura, Kiyomasa Nakatsuka, Kunihiro Nishimura, Chisato Izumi,
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Background

Female sex has been associated with poor prognosis in hypertrophic cardiomyopathy (HCM), but the factors contributing to this disparity remain insufficiently defined. We aimed to clarify sex differences in clinical characteristics and factors associated with cardiovascular death in Japan.

Methods

This multicenter, retrospective observational study of HCM was conducted between January 1, 2006, and December 31, 2018 (REVEAL‐HCM study [Multicenter Registry to Evaluate Risk Factors for Disease Progression, Sudden Cardiac Death and Adverse Clinical Outcomes in Japanese Patients With Hypertrophic Cardiomyopathy]; UMIN000046932). Patients aged ≥16 years with HCM were enrolled. Baseline characteristics and clinical outcomes including cardiovascular death were assessed. Univariable and multivariable Cox proportional hazards models were used to identify factors associated with cardiovascular death.

Results

Of 3247 patients (median age, 67 years; 43% women), women were older and more symptomatic at presentation (52% New York Heart Association class II–IV versus 35% in men). Cardiovascular death was more common in women (hazard ratio [HR], 1.37 [95% CI, 1.02–1.82]; P =0.03). In multivariable analysis, older age (per 1‐year increase; HR, 1.04 [95% CI, 1.02–1.06]), advanced New York Heart Association class (HR, 1.99 [95% CI, 1.40–2.82]), history of atrial fibrillation (HR, 1.55 [95% CI, 1.10–2.18]), greater maximal wall thickness indexed to body surface area (per 1‐mm/m 2 increase; HR, 1.12 [95% CI, 1.06–1.20]), and apical HCM (HR, 0.53 [95% CI, 0.32–0.88]) were independently associated with cardiovascular death, attenuating the HR for female sex.

Conclusions

Sex differences in clinical characteristics and outcomes were observed. The excess cardiovascular death in women with HCM was largely explained by older age, more advanced symptoms, greater indexed wall thickness, and sex‐specific differences in both the prevalence and prognostic impact of apical HCM.

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