(P283) SEX DIFFERENCES OF PULMONARY ARTERIAL HYPERTENSION PATIENTS WITH AND WITHOUT CARDIOPULMONARY COMORBIDITIES

Background: In contemporary registries, more patients diagnosed with pulmonary artery hypertension (PAH) have cardiopulmonary comorbidities (CPCs), complicating their clinical management. Despite women being more frequently diagnosed with PAH, a "sex paradox" exists where men experience worse outcomes. Understanding the factors contributing to this paradox, and the impact of CPCs is crucial for optimizing patient care. Therefore, this study’s objective is to evaluate sex differences of PAH patients with and without CPC.

METHODS AND RESULTS: Patients diagnosed with PAH at a tertiary hospital from January 2000 to May 2022 were separated into those with and without CPCs (Control). CPCs included obesity, hypertension, diabetes, coronary heart disease, and diffusing capacity for carbon monoxide < 45% (as suggested by 2021 ESC/ERS Pulmonary Hypertension Guidelines). Clinical data were retrospectively collected at time of diagnosis and most recent follow-up before May 2022.

In a cohort of 250 patients, 166 (66.4%) were female and 84 (33.6%) were male. A total of 198 (79.2%) of patients had at least one CPC and 59 (23.6%) had three or more. Overall, 20% of women had three or more CPCs, compared to 30% of men (Table 1). Furthermore, 87 (52.4%) females and 53 (63.1%) males had a NYHA class of 3 or greater, at their diagnosis visit. Compared to men with three or more CPCs, females with three or more CPCs had a lower baseline eGFR (63.05 mL/min/1.73 m²), lower baseline 6MWD (141.25 m), and were older at diagnosis (63.53 years). Over a median of 45 months, the cumulative event rate of heart failure hospitalization (HFH), cardiovascular (CV) death, or transplant in patients with any CPCs was 62.1% in women and 37.8% in men. Having three or more CPCs was an independent predictor of a composite outcome (HFH, CV death, or transplant) (HR: 1.80: p=0.027). Amongst those with CPCs, 6MWD and NYHA functional class were independent predictors of this composite outcome in women (HR: 0.74: p=0.011 and HR: 2.25: p=0.004). These variables did not show the same predictive significance in men (HR: 0.74: p=0.060 and HR: 0.93: p=0.904).

Conclusion: CPCs are common in a real-world registry of patients with PAH. Despite having less CPC burden, women had worse renal function, functional capacity and a worse overall prognosis compared to men. These findings underscore the importance of understanding sex-specific differences in CV disease. Ensuring that healthcare approaches are inclusive and responsive to sex-based needs can help reduce disparities in cardiovascular outcomes.