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Differences between men and women exist in their organs as well as in their outward appearances. When it comes to heart failure, for example, men are more likely to die than women are. It turns out there are also gender differences in responses to standard heart failure drug therapy, according to a review of data presented at the 11th Annual Scientific Meeting of the Heart Failure Society of America (HFSA), September 16–19, in Washington, D.C.
Specifically, women with heart failure appear to do better on angiotensin II receptor-blockers (ARBs) than on the more standard heart failure therapy—angiotensin-converting enzyme (ACE) inhibitors—said Jalal Ghali, MD, who discussed findings from a study published earlier this year.1 The data on almost 20,000 men and women indicate that women on ARBs have significantly lower mortality rates than those on ACE inhibitors do.
Why might women with heart failure benefit more from ARBs than from ACE inhibitors?
The answer is not clear; both ARBs and ACE inhibitors are used to control blood pressure by counteracting the heightened neurohormonal system activated in heart failure. Both drugs inhibit the hormone angiotensin, but they do so through different mechanisms.
And while the ARB mechanism seems to benefit women more, the ACE inhibitor mechanism appears to benefit nonhypertensive men more, notes Ghali, director of the Heart Failure Program at Wayne State University in Detroit. (Hypertensive men have comparable survival rates on ARBs and ACE inhibitors.)
The findings of this study jibe with those of past studies of ACE inhibitors and ARBs in heart failure, says Ghali, who is troubled by the fact that ACE inhibitors remain the other standard therapy for both men and women, when ARBs show such differential benefits for women.2–4
"When you look at ARBs, the picture is quite different for women and men with heart failure," says Ghali. "The benefits appear to be more significant for women."
Based on this data, Ghali believes current heart failure treatment guidelines should be revised, though it should be noted that ARBs generally cost more than ACE inhibitors.
"ARBs, rather than ACE inhibitors, need to be considered in treating
women with heart failure," he says. "Why not make the
recommendation now?" 
Footnotes
Current heart failure treatment guidelines from the American College of Cardiology and American Heart Association are available at http://circ.ahajournals.org/cgi/content/full/104/24/2996.
The current heart failure practice guideline from HFSA is available at www.heartfailureguideline.org.
References
2. O'Meara E, Clayton T, McEntegart MB, et al.: Sex differences in
clinical characteristics and prognosis in a broad spectrum of patients with
heart failure: Results of the Candesartan in Heart Failure: Assessment of
Reduction in Mortality and Morbidity (CHARM) program.
Circulation 115:3111–3120, 2007.
3. Garg R, Yusuf S: Overview of randomized trials of
angiotensin-converting enzyme inhibitors on mortality and morbidity in
patients with heart failure: Collaborative Group on ACE Inhibitor Trials.
JAMA 273:1450–1456, 1995.
4. Shekelle PG, Rich MW, Morton SC, et al.: Efficacy of
angiotensin-converting enzyme inhibitors and beta-blockers in the management
of left ventricular systolic dysfunction according to race, gender, and
diabetic status: A meta-analysis of major clinical trials. J Am
Coll Cardiol 41:1529–1538, 2003.
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