Sex-based differences in veterans with pulmonary hypertension: Results from the veterans affairs-clinical assessment reporting and tracking database

Corey E. Ventetuolo, Edward Hess, Eric D. Austin, Anna E. Barón, James R. Klinger, Tim Lahm, Thomas M. Maddox, Mary E. Plomondon, Lauren Thompson, Roham T. Zamanian, Gaurav Choudhary, Bradley A. Maron

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Women have an increased risk of pulmonary hypertension (PH) but better survival compared to men. Few studies have explored sex-based differences in population-based cohorts with PH. We sought to determine whether sex was associated with hemodynamics and survival in US veterans with PH (mean pulmonary artery pressure [mPAP] ≥ 25 mm Hg) from the Veterans Affairs Clinical Assessment, Reporting, and Tracking database. The relationship between sex and hemodynamics was assessed with multivariable linear mixed modeling. Cox proportional hazards models were used to compare survival by sex for those with PH and precapillary PH (mPAP ≥ 25 mm Hg, pulmonary artery wedge pressure [PAWP] ≤ 15 mm Hg and pulmonary vascular resistance [PVR] > 3 Wood units) respectively. The study population included 15,464 veterans with PH, 516 (3%) of whom were women; 1,942 patients (13%) had precapillary PH, of whom 120 (6%) were women. Among those with PH, women had higher PVR and pulmonary artery pulse pressure, and lower right atrial pressure and PAWP (all p <0.001) compared with men. There were no significant differences in hemodynamics according to sex in veterans with precapillary PH. Women with PH had 18% greater survival compared to men with PH (adjusted HR 0.82, 95% CI 0.69–0.97, p = 0.020). Similarly, women with precapillary PH were 29% more likely to survive as compared to men with PH (adjusted HR 0.71, 95% CI 0.52–0.98, p = 0.040). In conclusion, female veterans with PH have better survival than males despite higher pulmonary afterload.

Original languageEnglish (US)
Article numbere0187734
JournalPLoS One
Volume12
Issue number11
DOIs
StatePublished - Nov 1 2017

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veterans
Veterans
Pulmonary Hypertension
Sex Characteristics
hypertension
lungs
Databases
gender
Hemodynamics
pulmonary artery
Survival
Pulmonary Artery
hemodynamics
Pulmonary Wedge Pressure
Hazards
Wood
Vascular Resistance
blood vessels
Pressure
Atrial Pressure

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Sex-based differences in veterans with pulmonary hypertension : Results from the veterans affairs-clinical assessment reporting and tracking database. / Ventetuolo, Corey E.; Hess, Edward; Austin, Eric D.; Barón, Anna E.; Klinger, James R.; Lahm, Tim; Maddox, Thomas M.; Plomondon, Mary E.; Thompson, Lauren; Zamanian, Roham T.; Choudhary, Gaurav; Maron, Bradley A.

In: PLoS One, Vol. 12, No. 11, e0187734, 01.11.2017.

Research output: Contribution to journalArticle

Ventetuolo, CE, Hess, E, Austin, ED, Barón, AE, Klinger, JR, Lahm, T, Maddox, TM, Plomondon, ME, Thompson, L, Zamanian, RT, Choudhary, G & Maron, BA 2017, 'Sex-based differences in veterans with pulmonary hypertension: Results from the veterans affairs-clinical assessment reporting and tracking database', PLoS One, vol. 12, no. 11, e0187734. https://doi.org/10.1371/journal.pone.0187734
Ventetuolo, Corey E. ; Hess, Edward ; Austin, Eric D. ; Barón, Anna E. ; Klinger, James R. ; Lahm, Tim ; Maddox, Thomas M. ; Plomondon, Mary E. ; Thompson, Lauren ; Zamanian, Roham T. ; Choudhary, Gaurav ; Maron, Bradley A. / Sex-based differences in veterans with pulmonary hypertension : Results from the veterans affairs-clinical assessment reporting and tracking database. In: PLoS One. 2017 ; Vol. 12, No. 11.
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abstract = "Women have an increased risk of pulmonary hypertension (PH) but better survival compared to men. Few studies have explored sex-based differences in population-based cohorts with PH. We sought to determine whether sex was associated with hemodynamics and survival in US veterans with PH (mean pulmonary artery pressure [mPAP] ≥ 25 mm Hg) from the Veterans Affairs Clinical Assessment, Reporting, and Tracking database. The relationship between sex and hemodynamics was assessed with multivariable linear mixed modeling. Cox proportional hazards models were used to compare survival by sex for those with PH and precapillary PH (mPAP ≥ 25 mm Hg, pulmonary artery wedge pressure [PAWP] ≤ 15 mm Hg and pulmonary vascular resistance [PVR] > 3 Wood units) respectively. The study population included 15,464 veterans with PH, 516 (3{\%}) of whom were women; 1,942 patients (13{\%}) had precapillary PH, of whom 120 (6{\%}) were women. Among those with PH, women had higher PVR and pulmonary artery pulse pressure, and lower right atrial pressure and PAWP (all p <0.001) compared with men. There were no significant differences in hemodynamics according to sex in veterans with precapillary PH. Women with PH had 18{\%} greater survival compared to men with PH (adjusted HR 0.82, 95{\%} CI 0.69–0.97, p = 0.020). Similarly, women with precapillary PH were 29{\%} more likely to survive as compared to men with PH (adjusted HR 0.71, 95{\%} CI 0.52–0.98, p = 0.040). In conclusion, female veterans with PH have better survival than males despite higher pulmonary afterload.",
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AU - Klinger, James R.

AU - Lahm, Tim

AU - Maddox, Thomas M.

AU - Plomondon, Mary E.

AU - Thompson, Lauren

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AU - Choudhary, Gaurav

AU - Maron, Bradley A.

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