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European Journal of Heart Failure 2007 9(6-7):594-601; doi:10.1016/j.ejheart.2007.03.004
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© 2007 European Society of Cardiology

Angiotensin-converting enzyme inhibitors and survival in women and men with heart failure

Golyar Keyhan, Shun-Fu Chen and Louise Pilote*

Division of Clinical Epidemiology, The Research Institute of the McGill University Health Centre, 1650 Cedar Avenue, Room L10-421, Montreal, QC, Canada H3G 1A4

* Corresponding author. Tel: +1 514 934 1934x44722; fax: +1 514 934 8293. E-mail address: louise.pilote{at}mcgill.ca


  Abstract

Background: Several randomized controlled trials demonstrate that angiotensin-converting enzyme (ACE) inhibitors improve survival in patients with congestive heart failure (CHF). However, whether ACE inhibitors benefit both sexes is not adequately addressed.

Purpose: Our objective was to determine the effectiveness of ACE inhibitors in women with CHF.

Methods: The Quebec hospital discharge database was linked with the physician and drug claims database to identify a cohort with a discharge diagnosis of CHF between January 1998 and March 2003. In this retrospective cohort study, subjects who filled a prescription for ACE inhibitors (19,220 exposed) were compared to those who never filled such prescription (8617 non-exposed). The primary outcome was survival by exposure to ACE inhibitors.

Main findings: There were 14,693 women (67% exposed) and 13,144 men (72% exposed). The 1 year mortality was 19.5% and 30% in those exposed and non-exposed, respectively. A significant survival benefit was demonstrated in both sexes exposed to ACE inhibitors [adjusted hazard ratio (95% confidence interval): women 0.80 (0.76–0.85); men 0.71 (0.67–0.75)].

Principal conclusions: ACE inhibitors improve survival in both sexes with CHF, but the protective effect appears to be greater in men. Our results support the current recommendations for the management of women with CHF.

Key Words: Angiotensin-converting enzyme inhibitors • Congestive heart failure • Sex • Survival • Medication exposure

Received May 3, 2006; Revised December 4, 2006; Accepted March 8, 2007


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