Impact of sex and age on long-term prognosis in hypertrophic cardiomyopathy: A multicenter retrospective cohort study.

BACKGROUND

Previous studies have shown inconsistent conclusions regarding the prognosis of hypertrophic cardiomyopathy (HCM) patients based on sex.

OBJECTIVES

This study aims to explore sex differences across different age groups and long-term prognosis of HCM.

METHODS

This retrospective study included 2781 patients diagnosed with HCM. The median follow-up duration for the overall cohort was 4.54 years (interquartile range: 2.13-7.99 years), and 61.7% (n = 1717) were male patients. The main outcomes assessed were all-cause mortality/cardiac transplantation and cardiovascular events, analyzed using Kaplan-Meier survival curves and Cox regression analysis. Furthermore, competing risks regression analysis was performed. Restricted cubic splines (RCS) were employed to examine the potential association between age and prognosis across different sex groups.

RESULTS

A total of 519 patients (18.7%) experienced all-cause mortality/cardiac transplantation, with 292 patients (10.5%) succumbing to cardiovascular events. Female patients demonstrated a higher risk of both all-cause mortality/cardiac transplantation (P = 0.001) and cardiovascular events (P = 0.001) compared to males. Significant age-related differences were observed for both all-cause mortality/cardiac transplantation (P < 0.0001) and cardiovascular events (P < 0.0001) across sex. Multivariate Cox regression analysis indicated that age was an independent predictor of all-cause mortality/cardiac transplantation [HR: 1.038; 95% CI: 1.027-1.049; P < 0.001] and cardiovascular events [HR: 1.02; 95% CI: 1.006-1.033; P = 0.004] in males. Conversely, in females, age was the only independent predictor of all-cause mortality/cardiac transplantation [HR: 1.016; 95% CI: 1.004-1.028; P = 0.01].

CONCLUSION

Female HCM patients face higher all-cause mortality/cardiac transplantation and cardiovascular events than males. Advancing age increases both risks in the whole population and within each sex subgroup.