In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

The free consultation period for this content is over.

It is now only available year-round to HFA Silver & Gold Members, Fellows of the ESC and Young combined Members

Nitrates in female patients with diabetes mellitus and without diabetes mellitus in reduced ejection fraction heart failure

Session Poster Session 3

Speaker Dilek Ural

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : G Kozdag (Kocaeli,TR), D Ural (Istanbul,TR), K Karauzum (Kocaeli,TR), I Karauzum (Kocaeli,TR), J Wiley (New York,US), C Sanina (New York,US), C Baydemir (Kocaeli,TR), T Sahin (Kocaeli,TR), E Ural (Kocaeli,TR), U Bildirici (Kocaeli,TR), A Agacdiken Agir (Kocaeli,TR)

G Kozdag1 , D Ural2 , K Karauzum1 , I Karauzum1 , J Wiley3 , C Sanina4 , C Baydemir5 , T Sahin1 , E Ural1 , U Bildirici1 , A Agacdiken Agir1 , 1Kocaeli University, Faculty of Medicine, Department of Cardiology - Kocaeli - Turkey , 2Koc University, Cardiology - Istanbul - Turkey , 3Albert Einstein College of Medicine, Cardiology - New York - United States of America , 4Montefiore Medical Center (Bronx) - New York - United States of America , 5Kocaeli University, Department of Biostatistics - Kocaeli - Turkey ,


Back Ground: Although sex-specific differences in cardiovascular medicine are well known, the exact influences of sex on the effect of cardiovascular drugs remain unclear. Women and men differ in body composition and physiology and pharmacodynamics, so that is not rare that they may respond differently to cardiovascular drugs. Patients may also have multiple comorbidities at the same time. Clinical guidelines for the management of type 2 diabetes (DMII) recommend individual therapy. If treatment is individualized for every patients the prognosis could be better in patients with multiple comorbidities. Organic nitrates remain among the oldest and most commonly employed drugs in cardiology. This study aims to evaluate the effects of oral nitrates on all-cause mortality in reduced ejection fraction heart failure (HFrEF) patients according to their genders and the presence or the absence of DM using GDMT.
Method:  399 male patients and 231 female patients with HFreF were recruited into the study. There was no age differences between the groups, the male patients’ ejection fraction was lower than the female patients’ EF.  Almost 40% of the males and the females had DM. There was no difference for the treatment of oral nitrates between the female group and the male group (Table 1). 66 patients (44%) who had  DM were on the nitrates in the male group, 33 patients (33%) who had DM were on the nitrates in the female group, p=Not significant (NS).
Results: 207 male patients (52 %) and 106 female patients (46%) of the cohort died during a median follow-up duration of 54 months, p=NS. While 24 of female patients (62%) without DM who were on the oral nitrate treatment died, 36 of female patients (39%) without DM who weren’t on the oral nitrate treatment died p=0.016 during follow-up. There was no statistical difference for all-cause mortality between the females with the oral nitrate treatment and the females without the oral nitrate treatment in patients with DM. We did not determine any difference among  the males with or without DM who were on the nitrate or were not on the nitrate in the patients with HFreF in this study.
Conclusion: We determined that there was more all-cause mortality in the female patients without DM who was on the nitrate treatment in the study.

Male (n=399)

Female (n=231)


Age (years)

66± 11

66± 13


Ejection fraction (%)

24 ± 9

27± 10



151 (38%)

99 (43%)


Nitrate treatment

72 (31%)

154 (39%)


Get your access to resources

Join now
  • 1ESC Professional Members – access all ESC Congress resources 
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s resources
  • 3Under 40 or in training - with a Combined Membership, access all resources
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are