治療心衰竭藥物之性別差異

Sex-Related Differences in Medications for Heart Failure

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。

Current research suggests potential sex-related differences in heart failure treatment. Variations in body structure, cardiovascular physiology, and hormonal changes between men and women lead to differences in pharmacokinetics and pharmacodynamics. A key factor contributing to the unclear understanding of sex differences is the underrepresentation of women in clinical drug development. This article reviews the association between the heart failure treatment and sex based on the existing literature. Among them, angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists (MRAs), and angiotensin receptor/ neprilysin inhibitors (ARNIs) have shown promise in reducing mortality and hospitalization rates in women. However, no sex-differences were observed with beta-blockers and ivabradine. Additionally, diuretics, digoxin, and sodium-glucose cotransporter-2 inhibitors (SGLT 2Is) were found to have higher adverse events in women. Based on the above, there may be a relationship between sex and drug therapy efficacy for heart failure. While most current literature discusses sex-differences in heart failure medication use for patients with reduced ejection fraction (HFrEF), a high-level literature supporting this is lacking. This article aims to provide a better understanding of relevant information for clinical reference