治療心衰竭藥物之性別差異

目前的研究發現，心衰竭治療可能存在著性別上的差異，儘管男性與女性存在身體結構、心血管生理學、荷爾蒙變化等差異，致使藥物動力學及藥效學的不同外，最主要還是女性族群在臨床藥物開發的各個階段代表性不足，導致藥物的藥效與安全性，未被明確探討性別間的差異。本文以現有文獻回顧心衰竭的治療藥物與性別之間的關聯性；其中，血管收縮素受體阻斷劑（angiotensin receptor blockers, ARBs）、礦物性皮質激素受體拮抗劑（mineralocorticoid receptor antagonists, MRAs）及血管張力素受體－腦啡肽酶抑制劑（angiotensin receptor/neprilysin inhibitors, ARNIs）在女性族群使用，可降低死亡率及住院率，然而，乙型阻斷劑（beta-blocker）與ivabradine則無性別差異。此外，利尿劑（diuretics）、毛地黃（digoxin）及第二型鈉－葡萄糖共同轉運蛋白抑制劑（sodium-glucose cotransporter-2 inhibitors, SGLT2Is）反而在女性族群看到較高的不良反應發生。綜合上述，性別與心衰竭藥物間的療效可能有某種程度關性，既使目前文獻大多探討心衰竭用藥用於低左心室射血分率的收縮性心衰竭（heart failure with reduced ejection fraction, HFrEF）病人之性別差異，以及尚缺乏證據等級較高的文獻加以佐證，我們仍希望藉由本文提供相關資訊的進一步認識，以供臨床參考。

關鍵字

心衰竭；性別差異；療效；不良反應

並列摘要

Current research has found that there may be sex-differences in the treatment of heart failure. Although there are differences in body structure, cardiovascular physiology, and hormonal changes between men and women, resulting in differences in pharmacokinetics and pharmacodynamics. The main reason is that the women population is underrepresented at all stages of clinical drug development, resulting in the lack of clear sex-differences in the efficacy and safety of drugs. This article reviews the association between the treatment of heart failure and sex based on the existing literatures. Among them, angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists (MRAs) and angiotensin receptor/ neprilysin inhibitors (ARNIs) in women can reduce mortality and hospitalization rates. However, there is no sex-difference between beta-blockers and ivabradine. In addition, diuretics, digoxin, and sodium-glucose cotransporter-2 inhibitors (SGLT2Is) were found to have higher adverse events in women. Based on the above, there may be some relationship between sex and efficacy of drug therapy for heart failure. Even though most of the current literature discusses sex-differences in the use of heart failure medication for heart failure with reduced ejection fraction (HFrEF) patients, and there is still a lack of high-level literature to support it. We still hope to provide further understanding of relevant information through this article for clinical reference.

並列關鍵字

Heart failure ； Sex-related differences ； Efficacy ； Adverse events

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