Chest
Original ResearchPulmonary Vascular DiseaseSex Differences in the Diagnosis, Treatment, and Outcome of Patients With Pulmonary Arterial Hypertension Enrolled in the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management
Section snippets
Study Design and Population
The REVEAL Registry design and baseline characteristics have been previously described.7, 8 REVEAL Registry is a 55-center (university-affiliated and community hospitals), observational, prospective, US-based study of approximately 3,500 patients with newly and previously diagnosed PAH (group 1 pulmonary hypertension) aged ≥ 3 months at diagnosis. Patients were consecutively enrolled from March 2006 through September 11, 2007 and are followed for at least 5 years from time of enrollment. The
Patient Characteristics
Of the 2,969 patients meeting the analysis criteria, 2,318 (78%) were women. The mean ± SD age at enrollment was 49 ± 18 years for men and 51 ± 16 years for women. Demographic characteristics are provided in Table 1. The percentage of patients with IPAH, FPAH, and APAH was similar for males and females. There were no significant sex differences in cause at diagnosis among patients with IPAH (P = .85), FPAH (P = .23), or APAH. (P = .71). However, among APAH subtypes, more women had CTD (P <
Discussion
Consistent with other PAH registries, the majority of patients in the REVEAL Registry are female. Both IPAH and APAH had similar proportions of men and women. However, among the APAH subgroups, there were clear differences. More men have APAH due to HIV or PoPH, and more women have CTD-APAH and CHD-APAH. More men reported using or having used recreational drugs, whereas the use of appetite suppressants has a female predominance. Reported depression, obesity, and thyroid disorders appeared as
Conclusions
The size of the REVEAL Registry afforded us an opportunity to look at male patients with PAH and compare them to females with PAH. Our findings highlight the similarities and differences between sexes and raise questions for future exploration into the role of hormones in causation and survival in PAH. The data also provide reassurance that the diagnosis and treatment of PAH is similar between men and women.
Acknowledgments
Author contributions: Dr Shapiro: contributed to the study design; collection, analysis, and interpretation of data; drafting and critical review of the manuscript; and has seen and approved the final version.
Ms Traiger: contributed to the study design; collection, analysis, and interpretation of data; drafting and critical review of the manuscript; and has seen and approved the final version.
Ms Turner: contributed to the study design; collection, analysis, and interpretation of data; drafting
References (17)
- et al.
Temporal trends and drug exposures in pulmonary hypertension: an American experience
Am Heart J
(2006) - et al.
Registry and survival study in Chinese patients with idiopathic and familial pulmonary arterial hypertension
Chest
(2007) - et al.
Pulmonary arterial hypertension: baseline characteristics from the REVEAL Registry
Chest
(2010) - et al.
Design of the REVEAL registry for US patients with pulmonary arterial hypertension
Mayo Clin Proc
(2008) - et al.
Updated clinical classification of pulmonary hypertension
J Am Coll Cardiol
(2009) - et al.
Diagnosis and assessment of pulmonary arterial hypertension
J Am Coll Cardiol
(2009) - et al.
Primary pulmonary hypertension. A national prospective study
Ann Intern Med
(1987) - et al.
A USA-based registry for pulmonary arterial hypertension: 1982-2006
Eur Respir J
(2007)
Cited by (139)
Investigating the “sex paradox” in pulmonary arterial hypertension: Results from the Pulmonary Hypertension Association Registry (PHAR)
2024, Journal of Heart and Lung TransplantationImpact of sex on outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension
2023, Journal of Heart and Lung TransplantationInterplay of sex hormones and long-term right ventricular adaptation in a Dutch PAH-cohort
2022, Journal of Heart and Lung TransplantationSex Differences and the Role of Sex Hormones in Pulmonary Hypertension
2021, Clinics in Chest Medicine
Funding/Support: Funding for the REVEAL Registry is provided by Actelion Pharmaceuticals US, Inc.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).