No relevant sex-based differences in hemodynamic parameters have been described until now but the course of any
heart disease may be modified by factors that act differently in men and women. In a study comparing the incidence
of heart disease and patient survival over the past 50 years, the incidence of heart failure was found to have declined
in women but not in men.With increased sodium excretion and obesity, the hazard ratios for cardiovascular mortality
were higher in women. A post-hoc subgroup analysis of the DIG study was conducted to assess potential sex-based
differences in the effect of digoxin. The authors conclude that digoxin therapy is associated with an increased risk
of death in women (P=0.34). The comparison of the effects of digoxin was limited simply to gender only and no
other subgroup analyses were preformed although the characteristics of the patients show significant differences in
more than 20 parameters. Hence, the conclusion of these authors can hardly be accepted. Contrary to these partly
conflicting data, the primary results from the Women’s Health Initiative randomized controlled trial focused on
defining the risks and benefits of hormone replacement in postmenopausal women give an unambiguous answer:
combined estrogen/progestin therapy should not be initiated or continued for the primary prevention of coronary
heart disease, furthermore, it increases the risks of cardiovascular disease, breast cancer, venous thromboembolism
and biliary tract surgery.
clinical cardiology, mortality, digoxin, hormone replacement therapy.