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Background Long-term corticosteroid therapy is the standard of care for treatment of cardiac sarcoidosis (CS). The efficacy of long-term corticosteroid-sparing immunosuppression in CS is unknown. The goal of this study was to assess the efficacy of methotrexate with or without adalimumab for long-term disease suppression in CS, and to assess recurrence and adverse event rates after immunosuppression discontinuation. Methods and Results Retrospective chart review identified treatment-naive CS patients at a single academic medical center who received corticosteroid-sparing maintenance therapy. Demographics, cardiac uptake of 18-fluorodeoxyglucose, and adverse cardiac events were compared before and during treatment and between those with persistent or interrupted immunosuppression. Twenty-eight CS patients were followed for a mean 4.1 (SD 1.5) years. Twenty-five patients received 4 to 8weeks of high-dose prednisone (>30mg/day), followed by taper and maintenance therapy with methotrexate±low-dose prednisone (low-dose prednisone

BACKGROUND:Reproductive factors reflective of endogenous sex hormone exposure might have an effect on cardiac remodeling and the development of heart failure (HF). OBJECTIVES:This study examined the association between key reproductive factors and the incidence of HF. METHODS:Women from a cohort of the Women's Health Initiative were systematically evaluated for the incidence of HF hospitalization from study enrollment through 2014. Reproductive factors (number of live births, age at first pregnancy, and total reproductive duration [time from menarche to menopause]) were self-reported at study baseline in 1993 to 1998. We employed Cox proportional hazards regression analysis in age- and multivariable-adjusted models. RESULTS:Among 28,516 women, with an average age of 62.7 ± 7.1 years at baseline, 1,494 (5.2%) had an adjudicated incident HF hospitalization during an average follow-up of 13.1 years. After adjusting for covariates, total reproductive duration in years was inversely associated with incident HF: hazard ratios (HRs) of 0.99 per year (95% confidence interval [CI]: 0.98 to 0.99 per year) and 0.95 per 5 years (95% CI: 0.91 to 0.99 per 5 years). Conversely, early age at first pregnancy and nulliparity were significantly associated with incident HF in age-adjusted models, but not after multivariable adjustment. Notably, nulliparity was associated with incident HF with preserved ejection fraction in the fully adjusted model (HR: 2.75; 95% CI: 1.16 to 6.52). CONCLUSIONS:In post-menopausal women, shorter total reproductive duration was associated with higher riskofincident HF, and nulliparity was associated with higher risk for incident HF with preserved ejection fraction. Whetherexposure to endogenous sex hormones underlies this relationship should be investigated in future studies.

Introduction The prevalence of heart failure (HF) in men and women is similar. However, guideline directed medical and advanced heart therapies, including left ventricular assist devices (LVAD) and heart transplant (Htx) are underused in women. Hypothesis Sex-related differences are observed in advanced heart failure and may affect outcomes after LVAD and Htx. Methods TransAtlantic Registry on VAD and Transplant (TRAVIATA) is a retrospective, multinational (Italy, Sweden, Croatia, Netherlands, Belgium, USA) registry that includes patients with LVAD (HeartWare, Heartmate II) with bridge to transplant (BTT) strategy. Patients with HeartMate 3, BIVAD or total artificial heart devices were excluded. Primary outcomes include frequency of Htx, waitlist time and survival. Results A total of 524 patients (15.6% women) received LVAD with BTT treatment strategy from 2008 to 2017. Baseline characteristics between men and women were matched, including HVAD use (38.7% vs 47.6%, p = 0.142) with notable differences in LVEDD (7.0 (1.5) vs 6.3 (1.5) cm (IQR), p = 0.001), TAPSE (1.5 (0.5) vs 1.7 (0.5) cm (IQR), p = 0.02) and INTERMACS class 1-2 (43.3% vs 59.8%, p = 0.008). Frequency of Htx (57.9% vs 58.3%, p = 0.087) with a median waitlist time (369 (568) vs 311 (367) days (IQR), p = 0.07) was similar between men and women. Survival differences by Kaplan Meir analysis at 5 years (p = 0.925) were not observed. Post-LVAD complications were significant for increased stroke in women compared to men (24.4% vs 13.4%, p = 0.018). Conclusion In this multinational registry, there were no observed sex differences in frequency of Htx, waitlist time or survival. However, greater severity of disease at time of therapy in women may suggest delays in diagnosis or decision to enlist these patients for therapy, highlighting a potential discordance in use of advanced HF therapies by sex.

Heart failure is an important and growing public health problem in women. Risk factors for incident hospitalized heart failure with preserved ejection fraction (HFpEF) compared with heart failure with reduced ejection fraction (HFrEF) in women and differences by race/ethnicity are not well characterized. We prospectively evaluated the risk factors for incident hospitalized HFpEF and HFrEF in a multiracial cohort of 42 170 postmenopausal women followed up for a mean of 13.2 years. Cox regression models with time-dependent covariate adjustment were used to define risk factors for HFpEF and HFrEF. Differences by race/ethnicity about incidence rates, baseline risk factors, and their population-attributable risk percentage were analyzed. Risk factors for both HFpEF and HFrEF were as follows: older age, white race, diabetes mellitus, cigarette smoking, and hypertension. Obesity, history of coronary heart disease (other than myocardial infarction), anemia, atrial fibrillation, and more than one comorbidity were associated with HFpEF but not with HFrEF. History of myocardial infarction was associated with HFrEF but not with HFpEF. Obesity was found to be a more potent risk factor for African American women compared with white women for HFpEF (P for interaction=0.007). For HFpEF, the population-attributable risk percentage was greatest for hypertension (40.9%) followed by obesity (25.8%), with the highest population-attributable risk percentage found in African Americans for these risk factors. In this multiracial cohort of postmenopausal women, obesity stands out as a significant risk factor for HFpEF, with the strongest association in African American women. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000611.