Men diagnosed with the heart condition dilated cardiomyopathy (DCM) are 64 percent more likely to die than women with the same disease (of those enrolled, 12.4 percent of women and 19.1 percent of men died during this study), according to new research funded by the British Heart Foundation.
The condition made headlines in 2016 when it was revealed that DCM contributed to George Michael's death. This research could lead to new treatments for this common disease, if factors are found in women that protect their hearts from damage.
Researchers at Imperial College London investigated whether sex impacts the outcome of people living with DCM. The team analysed the data of 881 DCM patients (290 women and 591 men, median age 52 years) over approximately 5 years.
The team found that men with DCM were 64 percent more likely to die, compared to women. They also found that women's hearts were less severely scarred and the strongest pumping chamber in the heart was found to be more functional in women with DCM who had developed heart failure, compared to men. However surprisingly, women were 10 percent more likely to develop heart failure and had more severe symptoms, such as breathlessness and fatigue, compared to men.
Dilated cardiomyopathy is a condition affecting 260,000 people in the U.K. and is the leading cause of heart transplants worldwide. In people with DCM, the heart muscle becomes stretched and 'baggy' and is unable to pump blood around the body efficiently. To compensate, the heart works harder and over time, begins to tire and fail.
Currently, there is no cure for the condition itself and prognosis is poor. It is crucial that doctors are able to better identify those at higher risk of heart failure or death, and that more research is carried out to develop new treatments for people with DCM.
Now, the researchers hope to investigate whether female hormones could protect the heart from damage. If so, the team will work out how this happens and use this knowledge to develop a new treatment for people with DCM and protect families from the devastation it causes.
Dr. Sanjay Prasad, Reader in Cardiology at Imperial College London and Consultant Cardiologist at Royal Brompton and Harefield NHS Foundation Trust, said:
"Research has led to the discovery of some genes responsible for DCM, better recognition of the symptoms and earlier diagnosis. But we have so much more to do.
"I meet people with DCM every day and I've seen it devastate families. That's what drives me and my team to better understand how the disease develops and find those at the greatest risk of complications.
"Our research shows that men with DCM are at greater risk of death, compared to women. This insight should encourage doctors to manage male DCM patients more intensively, and better stratify those who should and shouldn't have more extensive treatment.
"Now, we want to explore what factors could be protecting the hearts of women. We will harness this knowledge and work towards developing new treatments for people with DCM."
Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said:
"All too often DCM progresses to heart failure – a chronic condition that takes the lives of thousands of people every year in the UK. To protect families from heartbreak, it is vital that we better understand conditions like DCM and identify those who are risk of developing heart failure or dying.
"Research like this helps give us clues about why some people's hearts may be better protected than others.
"We need to improve the public's awareness of serious heart conditions like DCM and continue to strive for innovate treatments that protect hearts from damage. These diseases are real, they are life-threatening and they need to be tackled."
Mark Heldt, a 52-year-old from West Norwood, London, was diagnosed with DCM after his Father sadly died of the same disease. Mark's Brothers Ricky and Philip were also diagnosed with DCM. Philip has since been fitted with three ICDs and is now awaiting a heart transplant.
Mark says: "I was in my mid-twenties when my Dad was diagnosed with DCM. That was the first we'd heard of the disease. After my Dad passed away, my siblings and I were called in for screening to see if we were at risk of my Dad's condition. Philip, Ricky and I were diagnosed with DCM. We were in complete shock.
"My brother Philip's life has been affected the most. He struggles with chronic fatigue and has deteriorated so badly that he's now awaiting a heart transplant.
"With my family being put through the mill, I know firsthand how incredibly important research is. We need to know who is most at risk, and find better treatments."
Deb Coleman, a 56-year-old freelance photographer from Swindon, was diagnosed with DCM after suffering a cardiac arrest while giving birth to her son, Cameron, in 1994. Deb takes daily medicine, but does not have symptoms and has been able to continue with her normal, busy life. Deb says:
"When I was diagnosed I thought my life would change. But it hasn't – I'm fine and I don't have any symptoms. I'm able to continue my work as a photographer, which I love.
"I know not everyone living with DCM is as lucky as me. If researchers can find out why some suffer more greatly than others and find a way to better protect people's hearts, then I support it wholeheartedly."
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Brian P. Halliday et al. Sex- and age-based differences in the natural history and outcome of dilated cardiomyopathy, European Journal of Heart Failure (2018). DOI: 10.1002/ejhf.1216
Ray E. Hershberger et al. Dilated cardiomyopathy: the complexity of a diverse genetic architecture, Nature Reviews Cardiology (2013). DOI: 10.1038/nrcardio.2013.105
Lars H. Lund et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Heart Transplantation Report—2017; Focus Theme: Allograft ischemic time, The Journal of Heart and Lung Transplantation (2017). DOI: 10.1016/j.healun.2017.07.019
Dennis M. McNamara et al. Clinical and Demographic Predictors of Outcomes in Recent Onset Dilated Cardiomyopathy, Journal of the American College of Cardiology (2011). DOI: 10.1016/j.jacc.2011.05.033