Sex differences in pharmacological treatment of heart failure: a meta-analysis of randomized trials.
Marte F van der Bijl, Niels T B Scholte, Julie A E van Oortmerssen et al.
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In 30 seconds
This systematic review and meta-analysis examined sex differences in pharmacological treatment effects across randomized heart failure trials and whether women’s representation influenced estimated efficacy. Among 139 trials including 292 027 patients, 28.1% of whom were women, 78 trials reported sex-stratified effects. Pooled results showed no difference in treatment efficacy between women and men (delta ln[REM] 0.00; 95% confidence interval (CI) -0.04 to 0.03; P = .85; I2 = 4.1%). Meta-regression also found no association between the proportion of women enrolled and treatment effects.
Key findings
- Across 78 trials with sex-stratified results, pooled treatment efficacy did not differ between women and men (delta ln[REM] 0.00; 95% confidence interval (CI) -0.04 to 0.03; P = .85; I2 = 4.1%).
- The 139 included trials enrolled 292 027 patients, of whom 28.1% were women.
- Women’s trial representation was not associated with sex differences in treatment effects (78 RCTs, P = .25) or overall efficacy (139 RCTs, P = .24).
Why it matters
The findings provide evidence against a substantial sex difference in the efficacy of pharmacological heart failure treatments studied in these trials, and suggest that women’s historical underrepresentation is unlikely to have concealed important differences. However, women made up only 28.1% of participants, so improving sex balance remains important for equitable evidence generation and for assessing outcomes across populations.
What to keep in mind
Only 78 of 139 trials reported sex-stratified treatment effects, limiting the pooled sex comparison. Women represented 28.1% of participants overall.