男性と女性における心不全薬の最適な用量を特定する:前向きな観察コホート研究
Bernadet T Santema1, Wouter Ouwerkerk2, Jasper Tromp3
1Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands.
Lancet (London, England)
|August 27, 2019
まとめ
心臓機能不全の女性では,ACE阻害剤やARBおよびβ阻害剤の投与量が男性より低い場合がある. この発見は 性別に基づいてHFrEF患者に対する最適な治療法を疑問視しています
科学分野:
- 心臓病科
- 薬理学について
- 臨床医学
背景:
- ACE阻害剤/ARBおよびベータブロック剤のガイドライン用量は,心臓機能不全とエジェクション分数減少 (HFrEF) の男性と女性の間で類似しています.
- 性別による薬剤動力学的差異は,性別最適投与の可能性を示唆する.
研究 の 目的:
- HFrEF患者に対するACE阻害剤/ARBおよびβ阻害剤の最適な用量における潜在的な性差を調べる.
主な方法:
- BIOSTAT- CHF試験のポストホック分析で,左心室エジェクション分数 < 40% を含む患者
- 独立したASIAN-HFコホートでの検証
- 主なアウトカム:全因死亡率または心不全による入院.
主要な成果:
- HFrEFを持つ女性は男性より年上で,体重と身長が低い.
- 男性では,ACE阻害剤/ ARBおよびβ阻害剤のガイドライン用量の100%で死亡率またはHF入院のリスクが最適に減少しました.
- 女性では,ガイドライン用量の50%で同様のリスク低下を達成し,より高い用量では追加の利益はありません.
結論:
- HFrEFを持つ女性は,男性よりも低いACE阻害剤/ARBおよびβ阻害剤を必要とします.
- これは,性差を考慮して,HFrEFの最適な治療法を再評価する必要性を強調しています.
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