Spironolactone for HFpEF Might Affect Men and Women Differently

Heart failure with preserved ejection fraction (HFpEF) occurs more commonly in women than men. In an exploratory analysis of possible sex differences in the response to spironolactone in these patients, investigators made use of data from the randomized, placebo-controlled TOPCAT study in stable outpatients with HFpEF (NEJM JW Cardiol May 2014 and N Engl J Med 2014; 370:1383).

The current analysis was restricted to the 1767 patients from the Americas, about half of whom were women. In both men and women in the spironolactone arm, serum potassium and creatinine concentrations increased, and systolic blood pressure declined. On the primary composite outcome (cardiovascular death, HF hospitalization, and cardiac arrest), treatment and sex showe…