There appear to be key differences between men and women regarding prevalence, prognosis and survival in wild-type transthyretin amyloid cardiomyopathy (ATTR-CM), according to a study recently published in the journal Amyloid.
Wild-type ATTR-CM was previously thought to affect more men than women; however, several autopsy studies have shown that the disease has a similar prevalence in both men and women. In light of these findings, many experts hypothesize that wild-type ATTR-CM is underdiagnosed in women due to key differences in clinical presentation between the sexes.
Therefore, the authors aimed to assess sex-based differences in wild-type ATTR-CM through a retrospective study including data from over 1,000 patients diagnosed between 2008 and 2022.
Women are diagnosed at a more advanced age than men
The results showed that, on average, women were diagnosed at a more advanced age than men. However, there were no significant differences in disease severity, as determined by the New York Heart Association (NYHA) score, between men and women at the time of diagnosis.
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Differences in clinical characteristics
Women in the study were more likely to have neurological symptoms than men and tended to have higher troponin levels. Troponin is a marker of heart muscle injury and is associated with more severe disease.
Additionally, women had thinner heart walls than men when analyzed through echocardiography. The left ventricular ejection fraction (the amount of blood ejected from the ventricle per beat), on the other hand, was higher in women than in men.
In ATTR-CM, heart thickness is typically increased and ejection fraction is typically decreased. As heart wall thickness and ejection fraction are key diagnostic markers for heart failure and ATTR-CM, the previous finding suggests that these sex-based differences could contribute to ATTR-CM underdiagnosis in women. The study’s authors suggested that introducing sex-specific cut-off values could improve diagnosis in women.
“Decreasing the septum thickness cut-off would increase the frequency of ATTR-CM diagnosis in women,” the authors wrote.
Younger women have worse survival than younger men
The study’s authors observed that, in the population as a whole, there were no significant differences in five-year survival rates between men and women. However, when stratified by age, the youngest group of women had worse survival than their male counterparts.
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