Advertisement
Short communication| Volume 374, P116-119, March 01, 2023

Evolving epidemiology of transthyretin amyloid cardiomyopathy due to increased recognition in women

  • Author Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Mark Prasad
    Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Amyloidosis Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
    Search for articles by this author
  • Author Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Morris Kim
    Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Amyloidosis Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
    Search for articles by this author
  • Author Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Pranav Chandrashekar
    Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Amyloidosis Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
    Search for articles by this author
  • Author Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Yuanzi Zhao
    Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Amyloidosis Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
    Search for articles by this author
  • Author Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Katherine L. Fischer
    Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Amyloidosis Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
    Search for articles by this author
  • Author Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Babak Nazer
    Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Amyloidosis Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
    Search for articles by this author
  • Author Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Ahmad Masri
    Correspondence
    Corresponding author at: UHN-62, 3181 SW Sam Jackson Rd, Portland, OR 97239, USA.
    Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Amyloidosis Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
    Search for articles by this author
  • Author Footnotes
    1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Published:December 29, 2022DOI:https://doi.org/10.1016/j.ijcard.2022.12.048
Evolving epidemiology of transthyretin amyloid cardiomyopathy due to increased recognition in women
Previous ArticleCould carotid screening cause more harm than good?
Next ArticleRole of cardiac magnetic resonance in the differential diagnosis between arrhythmogenic cardiomyopathy with left ventricular involvement and previous infectious myocarditis.

      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.

      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.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Ruberg F.L.
        • Grogan M.
        • Hanna M.
        • Kelly J.W.
        • Maurer M.S.
        Transthyretin amyloid cardiomyopathy: JACC state-of-the-art review.
        J. Am. Coll. Cardiol. 2019; 73: 2872-2891
        View in Article
        • Nativi-Nicolau J.
        • Siu A.
        • Dispenzieri A.
        • Maurer M.S.
        • Rapezzi C.
        • Kristen A.V.
        • Garcia-Pavia P.
        • LoRusso S.
        • Waddington-Cruz M.
        • Lairez O.
        • Witteles R.
        • Chapman D.
        • Amass L.
        • Grogan M.
        • Investigators T.H.A.O.S.
        Temporal trends of wild-type transthyretin amyloid cardiomyopathy in the transthyretin amyloidosis outcomes survey.
        JACC CardioOncol. 2021 Oct 19; 3: 537-546
        View in Article
        • Gillmore J.D.
        • Maurer M.S.
        • Falk R.H.
        • Merlini G.
        • Damy T.
        • Dispenzieri A.
        • Wechalekar A.D.
        • Berk J.L.
        • Quarta C.C.
        • Grogan M.
        • Lachmann H.J.
        • Bokhari S.
        • Castano A.
        • Dorbala S.
        • Johnson G.B.
        • Glaudemans A.W.
        • Rezk T.
        • Fontana M.
        • Palladini G.
        • Milani P.
        • Guidalotti P.L.
        • Flatman K.
        • Lane T.
        • Vonberg F.W.
        • Whelan C.J.
        • Moon J.C.
        • Ruberg F.L.
        • Miller E.J.
        • Hutt D.F.
        • Hazenberg B.P.
        • Rapezzi C.
        • Hawkins P.N.
        Nonbiopsy diagnosis of cardiac transthyretin amyloidosis.
        Circulation. 2016 Jun 14; 133: 2404-2412
        View in Article
        • Ng B.
        • Connors L.H.
        • Davidoff R.
        • Skinner M.
        • Falk R.H.
        Senile systemic amyloidosis presenting with heart failure: a comparison with light chain-associated amyloidosis.
        Arch. Intern. Med. 2005 Jun 27; 165: 1425-1429
        View in Article
        • Masri A.
        • Chen H.
        • Wong C.
        • Fischer K.L.
        • Karam C.
        • Gellad W.F.
        • Heitner S.B.
        Initial experience prescribing commercial Tafamidis, the Most expensive cardiac medication in history.
        JAMA Cardiol. 2020 Sep 1; 5: 1066-1067
        View in Article
        • Dorbala S.
        • Ando Y.
        • Bokhari S.
        • Dispenzieri A.
        • Falk R.H.
        • Ferrari V.A.
        • Fontana M.
        • Gheysens O.
        • Gillmore J.D.
        • Glaudemans A.W.J.M.
        • Hanna M.A.
        • Hazenberg B.P.C.
        • Kristen A.V.
        • Kwong R.Y.
        • Maurer M.S.
        • Merlini G.
        • Miller E.J.
        • Moon J.C.
        • Murthy V.L.
        • Quarta C.C.
        • Rapezzi C.
        • Ruberg F.L.
        • Shah S.J.
        • Slart R.H.J.A.
        • Verberne H.J.
        • Bourque J.M.
        ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: part 2 of 2-diagnostic criteria and appropriate utilization.
        J. Nucl. Cardiol. 2020 Apr; 27 (Erratum in: J. Nucl. Cardiol. 2021 Aug;28(4):1763–1767. PMID: 31468377): 659-673https://doi.org/10.1007/s12350-019-01761-5
        View in Article
        • United States Food and Drug Administration
        • Center for Drug Evaluation and Research
        Drug Approval Package: Vyndaqel & Vyndamax.
        https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/211996Orig1s000,%20212161Orig1s000TOC.cfm
        Date: 2019 May 3
        View in Article
        • Bourque J.M.
        • Schepart A.
        • Bhambri R.
        • Castaño A.
        • O’Brien A.
        • Chen Y.
        • Prasad S.
        • Roy A.
        • Grodin J.L.
        Temporal trends in diagnostic testing patterns for wild-type transthyretin amyloid cardiomyopathy in the medicare fee-for-service population.
        Am. J. Cardiol. 2022 Mar 15; 167: 98-103
        View in Article
        • Patel R.K.
        • Ioannou A.
        • Razvi Y.
        • Chacko L.
        • Venneri L.
        • Bandera F.
        • Knight D.
        • Kotecha T.
        • Martinez-Naharro A.
        • Masi A.
        • Porcari A.
        • Brown J.
        • Patel K.
        • Manisty C.
        • Moon J.
        • Rowczenio D.
        • Gilbertson J.A.
        • Sinagra G.
        • Lachmann H.
        • Wechalekar A.
        • Petrie A.
        • Whelan C.
        • Hawkins P.N.
        • Gillmore J.D.
        • Fontana M.
        Sex differences among patients with transthyretin amyloid cardiomyopathy – from diagnosis to prognosis.
        Eur. J. Heart Fail. 2022; (Accepted Author Manuscript)https://doi.org/10.1002/ejhf.2646
        View in Article
        • Aimo A.
        • Merlo M.
        • Porcari A.
        • Georgiopoulos G.
        • Pagura L.
        • Vergaro G.
        • Sinagra G.
        • Emdin M.
        • Rapezzi C.
        Redefining the epidemiology of cardiac amyloidosis. A systematic review and meta-analysis of screening studies.
        Eur. J. Heart Fail. 2022 May 4; (Epub ahead of print. PMID: 35509173)https://doi.org/10.1002/ejhf.2532
        View in Article
        • Batra J.
        • Rosenblum H.
        • Defilippis E.M.
        • Griffin J.M.
        • Saith S.E.
        • Gamino D.
        • Teruya S.
        • Santos J.L.
        • Helmke S.
        • Burkhoff D.
        • Maurer M.S.
        Sex differences in the phenotype of transthyretin cardiac amyloidosis due to Val122Ile mutation: insights from noninvasive pressure-volume analysis.
        J. Card. Fail. 2021 Jan; 27: 67-74
        View in Article
        • Maurer M.S.
        • Schwartz J.H.
        • Gundapaneni B.
        • et al.
        Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy.
        N. Engl. J. Med. 2018; 379: 1007-1016
        View in Article
        • Rapezzi C.
        • Elliott P.
        • Damy T.
        • Nativi-Nicolau J.
        • Berk J.L.
        • Velazquez E.J.
        • Boman K.
        • Gundapaneni B.
        • Patterson T.A.
        • Schwartz J.H.
        • Sultan M.B.
        • Maurer M.S.
        Efficacy of Tafamidis in patients with hereditary and wild-type transthyretin amyloid cardiomyopathy: further analyses from ATTR-ACT.
        JACC Heart Fail. 2021 Feb; 9: 115-123
        View in Article

      Article info

      Publication history

      Published online: December 29, 2022
      Accepted: December 28, 2022
      Received in revised form: December 3, 2022
      Received: October 9, 2022

      Identification

      DOI: https://doi.org/10.1016/j.ijcard.2022.12.048

      Copyright

      © 2022 Elsevier B.V. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX