Women with pulmonary hypertension have better survival chances than men

In patients with combined post- and pre-capillary pulmonary hypertension (CpcPH), the mortality risk was higher for men than for women. Also, having a mean pulmonary artery pressure (mPAP) above 46 mmHg was linked to a significantly lower probability of survival.

“The Swiss PH Registry is a collaboration between 13 Swiss hospitals that has been established in 1998, and includes patients with newly diagnosed pulmonary hypertension from 2000 onwards,” stated Dr Anna Titz (University Hospital Zürich, Switzerland) [1]. Registry data from 2001–2019 served as a basis for a retrospective analysis that assessed epidemiology and long-term outcomes of patients with CpcPH [1,2]. CpcPH was defined by a mean mPAP over 20 mmHg and a pulmonary vascular resistance (PVR) above 2 Wood units. The study comprised a Kaplan-Meier survival analysis and a Cox regression analysis that included baseline characteristics, risk assessment strata, 6-minute-walking test scores, and BNP/NT-proBNP levels. The study cohort consisted of 231 patients, among them 137 women. Further assessment of demographics observed a mean age of 65, a mean mPAP of 48 mmHg, and a mean PVR of 7.2 Wood units. “Surprisingly, our data shows that 47% of our cohort received PH-targeted medication,” Dr Titz emphasised, while mentioning the conflicting evidence that currently exists regarding these medication in patients with PH based on left heart disease.

The results demonstrated a statistically significant higher survival probability for women compared with men (P=0.011). One factor influencing survival was mPAP, as having an mPAP over 46 mmHg was linked to higher mortality (P=0.035). “We also stratified our patients according to the 4-strata risk assessment tool, by using the non-invasively assessed parameters: functional class, 6-minute walking test, and NT-proBNP,” Dr Titz informed. These results showed that high-risk patients in the 4-strata risk assessment have a lower survival probability than those with low/intermediate risk. These findings were also corroborated by the results of the Cox regression analysis, with significant hazard ratios of 0.58 for being female, 1.58 for mPAP >46 mmHg, and 2.44 for high-risk patients (see Figure). However, a significant influence on survival of age or pulmonary vascular resistance could not be established.

“In this patient cohort with combined post- and pre-capillary pulmonary hypertension, women and patients with a lower mPAP revealed a longer survival,” Dr Titz summarised.

Figure: Cox regression analysis: Women have a statistically significant higher survival probability [1]

1. Titz A. Long-term outcome of patients with combined post- and precapillary pulmonary hypertension. Abstract 747, ERS 2023 Congress, 9–13 September, Milan, Italy.
2. Titz A, et al. Eur Heart J Open. 2023 Jul 3;3(4):oead069.

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Posted on 29 October, 202329 October, 2023