Related Experiment Video
Updated: Sep 24, 2025
Investigating the Pathogenesis of MYH7 Mutation Gly823Glu in Familial Hypertrophic Cardiomyopathy using a Mouse Model
Published on: August 8, 2022
Factors associated with excess female mortality in obstructive hypertrophic cardiomyopathy
Davood Javidgonbadi1, Maria Schaufelberger2, Ingegerd Östman-Smith3
1Department of Cardiology, Northern Älvsborg County Hospital, Trollhättan, Sweden.
Insights
Female patients with obstructive hypertrophic cardiomyopathy (oHCM) experience higher mortality due to advanced disease and less frequent beta-blocker use. Addressing these sex disparities in diagnosis and treatment can improve care for women with oHCM.
Area of Science:
- Cardiology
- Genetics
- Internal Medicine
Background:
- Several studies indicate higher mortality rates in female patients diagnosed with hypertrophic cardiomyopathy.
- The underlying causes for this observed sex disparity in hypertrophic cardiomyopathy outcomes remain largely unknown.
- Obstructive hypertrophic cardiomyopathy (oHCM) is a significant concern, particularly regarding sex-based differences in disease progression and mortality.
Purpose of the Study:
- To investigate and compare risk factors associated with disease-related death in both male and female patients within a geographical cohort of obstructive hypertrophic cardiomyopathy (oHCM).
- To identify sex-specific differences in disease presentation, risk factor distribution, and therapeutic interventions in oHCM patients.
- To analyze the impact of pharmacological treatments, such as beta-blockers and calcium-blockers, on mortality risk in relation to sex.
Main Methods:
- A cohort of 250 obstructive hypertrophic cardiomyopathy (oHCM) patients (123 female, 127 male) from the West Götaland Region was analyzed over a mean follow-up of 18.1 years.
- Cox-hazard regression and Kaplan-Meier survival analyses were employed to evaluate risk factors for disease-related death.
- Sex comparisons included distribution of risk factors and therapies in total and age-matched groups, with detailed analysis of baseline characteristics and treatment adherence.
Main Results:
- Females with oHCM were diagnosed at an older age (median 62 vs. 51 years) and presented with more advanced septal hypertrophy (10.6 vs. 9.6 mm/m2 BSA).
- Disease-related mortality was significantly higher in females (2.9% annually) compared to males (1.5%) in age-matched groups (P=0.010).
- Females received less frequent and lower-dose beta-blocker therapy post-diagnosis (64% vs. 78%), and higher mortality was observed across risk categories, including heart failure and myocardial infarction.
Conclusions:
- Significant sex disparities exist in obstructive hypertrophic cardiomyopathy (oHCM) presentation and outcomes, with females experiencing higher mortality.
- The findings highlight a potential link between delayed diagnosis, more advanced disease at presentation, and less aggressive pharmacological management in females.
- Optimizing the timing of diagnosis and tailoring pharmacological therapies, particularly beta-blocker regimens, for females with oHCM is crucial for improving survival rates and addressing sex disparities.
Background:
Several studies have reported excess female mortality in patients with hypertrophic cardiomyopathy, but the cause is unknown.
Aims:
To compare risk-factors for disease-related death in both sexes in a geographical cohort of patients with obstructive hypertrophic cardiomyopathy (oHCM).
Methods And Results:
Data-bases in all ten hospitals within West Götaland Region yielded 250 oHCM-patients (123 females, 127 males). Mean follow-up was 18.1 y. Risk-factors for disease-related death were evaluated by Cox-hazard regression and Kaplan-Meier survival-curves, with sex-comparisons of distribution of risk-factors and therapy in total and age-matched (n = 166) groups. At diagnosis females were older, median 62 y vs. 51 y, (P < 0.001), but not different in outflow-gradients and median NYHA-class. However, septal hypertrophy was more advanced: 10.6 [IQR = 3.2] vs. 9.6 [2.5] mm/m2 BSA; P = 0.002. Females had higher disease-related mortality than males (P = <0.001), with annual mortality 2.9% vs. 1.5% in age-matched groups (P = 0.010 log-rank). For each risk-category identified (NYHA-class ≥ III, outflow-gradient ≥50 mmHg), a higher proportion of females died (P = 0.0004; P = 0.001). Calcium-blocker therapy was a risk-factor (P = 0.005) and was used more frequently in females (P = 0.034). A beta-blocker dose above cohort-median reduced risk for disease-related death in both males (HR = 0.32; P = 0.0040) and in females (HR = 0.49; P = 0.020). Excess female deaths occurred in chronic heart-failure (P = 0.001) and acute myocardial infarctions (P = 0.015). Fewer females received beta-blocker therapy after diagnosis (64% vs. 78%, P = 0.018), in a smaller dose (P = 0.007), and less frequently combined with disopyramide (7% vs. 16%, P = 0.048).
Conclusion:
Addressing sex-disparities in the timing of diagnosis and pharmacological therapy has the potential to improve the care of females with oHCM.
Related Concept Videos
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:17Pathophysiology of Heart Failure
01:27Heart Failure I: Introduction
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:29Cardiomyopathy V: Interprofessional Care
01:30Coronary Artery Disease I: Introduction