Evolving epidemiology of transthyretin amyloid cardiomyopathy due to increased recognition in women. (1st March 2023)

• Record Type: Journal Article
• Authors: Prasad, Mark; Kim, Morris; Chandrashekar, Pranav; Zhao, Yuanzi; Fischer, Katherine L.; Nazer, Babak; Masri, Ahmad
• Is Part Of: International journal of cardiology. Volume 374(2023)
• Page Start: 116
• Page End: 119
• Publication Date: 2023-03-01
• Subjects: Cardiac amyloidosis -- Sex -- Epidemiology; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.12.048
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Transthyretin amyloid cardiomyopathy (ATTR-CM), particularly wild type (wtATTR-CM), is thought to mainly affect men. Non-invasive diagnosis and approved therapeutics have been associated with increased disease recognition. We investigated the trajectory of ATTR-CM diagnosis in women. Methods: This observational study utilized data collected on 140 consecutive ATTR-CM patients diagnosed between 2005 and 2022 who are followed at the Oregon Health and Science University Amyloidosis Clinic. Subgroup analysis was performed on patients with wtATTR-CM which included 113 subjects (80.1%). The proportion of women among patients diagnosed with ATTR-CM prior to 2019 was compared with that of those diagnosed 2019–2022 (2019 was the year of tafamidis approval by the FDA). The clinical characteristics of male and female ATTR-CM patients were compared as well. Results: Of the 140 ATTR-CM patients, 16 (11.4%) were women (age 77 ± 9 years) and 124 (88.6%) were men (age 76 ± 9 years). There was an increase in the rate of women diagnosed with ATTR-CM from pre 2019 to 2019–2022 in the overall cohort (4/68 [5.9%] vs 12/72 [16.7%]) and wild type subgroup (0/51 [0%] vs 7/62 [11.3%]). There were several differences in baseline clinical characteristics between women and men in this cohort, yet all women had a clear clinical phenotype of ATTR-CM. Conclusions: There has been a significant increase in the rate of wtATTR-CM diagnoses in women, who presented with clear phenotypes of ATTR-CM. Further studies are needed to understand the effect of increased recognition of ATTR-CM in women on disease epidemiology, natural history, and outcomes. Highlights: The phenotypic presentation of ATTR-CM is similar in women and men in this single center study Increased rate of diagnosis of ATTR-CM in women is driven by an increase in diagnosis of the wild type form. This increased diagnosis of wtATTR-CM in women is temporally related to the non-invasive diagnosis and tafamidis.