Women with aortic stenosis had a lower rate of all cause mortality and fewer ischaemic cardiovascular events then men, in a randomised controlled trial. However, rate of disease progression was similar for both genders.

Data were used from the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study, a randomised, double-blind, placebo-controlled trial which assessed the effect of combined treatment with simvastatin and ezetimibe on the progression of mild to moderate aortic stenosis and cardiovascular morbidity and mortality.

The sub-study was a prospectively planned analysis of those patients in whom left ventricular (LV) geometry could be assessed. Echocardiography and cardiovascular events were recorded during a median of 4.0 years in 979 men and 632 women aged 28-86 years. LV systolic function was assessed by ejection fraction and midwall shortening.

The outcomes were aortic stenosis-related events, ischaemic cardiovascular events and total mortality.

Aortic stenosis-related events included aortic valve replacement, hospitalisation for congestive heart failure caused by aortic stenosis or death from cardiovascular causes.

Ischaemic cardiovascular events included non-fatal myocardial infarction, hospitalisation for unstable angina, coronary revascularisation at the time of aortic valve replacement, non-haemorrhagic stroke and cardiovascular death.

Women and men had a similar rate of progression of aortic stenosis irrespective of the echo parameter used to assess severity (peak jet velocity, mean gradient or valve area). The authors performed multivariate analyses which showed that female gender independently predicted less reduction in LV function either by midwall score or ejection fraction during follow-up.

Compared with men women had:

• A 40% lower rate of ischaemic events: hazard ratio (HR) 0.60 (95% CI:0.46-0.79, P < 0.001) with

• More than a 50% lower rate of stroke: HR 0.47 (95% CI:0.26-0.85, P = 0.01) and coronary artery bypass grafting: HR 0.49 (95% CI:0.34-0.71, P < 0.001).

• A 31% lower all-cause mortality: HR 0.69 (95% CI:0.49-0.99, P = 0.04). This was independent of study treatment, age and hypertension.

However, the rate of events directly attributable to aortic stenosis did not differ by gender.

As the population ages aortic stenosis will become increasingly prevalent. The authors conclude that although both men and women had

a similar rate of progression of aortic stenosis and similar stenosis-related events, women had a lower rate of death from all causes and fewer ischaemic cardiovascular events compared with men.

Dr Peter Savill

• Cramariuc D, Rogge BP, Lønnebakken MT et al. Sex differences in cardiovascular outcome during progression of aortic valve stenosis. Heart 2015;101:209-214 doi:10.1136/heartjnl-2014-306078