{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T14:39:22Z","timestamp":1790433562363,"version":"4.1.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,7,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Women have higher vascular stiffness with aging. The aim of this study was to characterize sex differences in vascular and ventricular structure and function, and to investigate the impact on the primary outcome in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Data from the Americas cohort of the\n              <jats:styled-content style=\"fixed-case\">TOPCAT<\/jats:styled-content>\n              trial were analyzed. Patients with echocardiography (n=654) were compared according to sex, and achievement of the primary end point (a composite of death from cardiovascular causes and heart failure hospitalization) assessed. Echocardiography revealed higher arterial, systolic, and diastolic ventricular elastance and worse ventricular\u2010vascular coupling in women. Women had better overall survival and heart failure hospitalization outcomes (hazard ratio 0.74, 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              0.57\u20130.98,\n              <jats:italic>P<\/jats:italic>\n              =0.034), however, determinants of achievement of the primary outcome differed between the sexes. Pulse pressure was a key determinant of outcome in women (hazard ratio 1.04, 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              1\u20131.09,\n              <jats:italic>P<\/jats:italic>\n              =0.034) whereas in men heart rate (hazard ratio 1.61, 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              1.02\u20132.52 per 10\u00a0mm\u00a0Hg increase,\n              <jats:italic>P<\/jats:italic>\n              =0.04) and B\u2010type natriuretic peptide (hazard ratio 1.01, 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              1\u20131.02 per 10\u00a0ng\/mL increase\n              <jats:italic>P<\/jats:italic>\n              =0.02) were associated with poorer outcome.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Outcomes in patients with heart failure with preserved ejection fraction appear to be differentially influenced by key physiological factors that vary according to sex. In women, ventricular\u2010vascular stiffening was the most significant determinant of outcome, whereas in men overall survival was influenced by heart rate and B\u2010type natriuretic peptide; this highlights key sex differences in the pathophysiology and outcomes of heart failure with preserved ejection fraction and warrants further exploration.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Clinical Trial Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\">https:\/\/clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT00094302.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.012190","type":"journal-article","created":{"date-parts":[[2019,6,22]],"date-time":"2019-06-22T09:02:10Z","timestamp":1561194130000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":25,"title":["Impact of Sex on Ventricular\u2010Vascular Stiffness and Long\u2010Term Outcomes in Heart Failure With Preserved Ejection Fraction: TOPCAT Trial Substudy"],"prefix":"10.1161","volume":"8","author":[{"given":"Anna L.","family":"Beale","sequence":"first","affiliation":[{"name":"Department of Cardiology\rAlfred Hospital\rMelbourne Australia"},{"name":"Heart Failure Research Group\rBaker Heart and Diabetes Institute\rMelbourne Australia"},{"name":"Department of Medicine\rMonash University\rMelbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane","family":"Nanayakkara","sequence":"additional","affiliation":[{"name":"Department of Cardiology\rAlfred Hospital\rMelbourne Australia"},{"name":"Heart Failure Research Group\rBaker Heart and Diabetes Institute\rMelbourne Australia"},{"name":"Department of Medicine\rMonash University\rMelbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Kaye","sequence":"additional","affiliation":[{"name":"Department of Cardiology\rAlfred Hospital\rMelbourne Australia"},{"name":"Heart Failure Research Group\rBaker Heart and Diabetes Institute\rMelbourne Australia"},{"name":"Department of Medicine\rMonash University\rMelbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.031622"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs070"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jhh.1000689"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2003.018754"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(74)90089-7"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1089\/met.2016.0078"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000485"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.541078"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.112.191148"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01166-4"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jash.2013.05.007"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.05.029"},{"key":"e_1_3_1_14_2","first-page":"473","article-title":"The parallel tales of microvascular angina and heart failure with preserved ejection fraction: a paradigm shift","volume":"38","author":"Crea F","year":"2017","unstructured":"Crea F, Bairey Merz CN, Beltrame JF, Kaski JC, Ogawa H, Ong P, Sechtem U, Shimokawa H, Camici PG. 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