ArticleThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation2024
Investigating the "sex paradox" in pulmonary arterial hypertension: Results from the Pulmonary Hypertension Association Registry (PHAR).
Article in The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 39 citations in OpenAlex.
- Proteogenomic Profiling of Idiopathic Pulmonary Arterial Hypertension Identifies Sex-Differential Proteins and Candidate Therapeutic Targets.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- Effect of Incident Pulmonary Arterial Hypertension on Risk of Newly-Diagnosed Mental Health Conditions.Pulmonary circulation · 2026Article
- Trends and future projections of the disease burden of pulmonary arterial Hypertension-related heart failure in China and G20 countries: Based on the global burden of disease 2023 database.International journal of cardiology. Cardiovascular risk and prevention · 2026Article
- Hepatocyte growth factor may contribute to male protection against pulmonary arterial hypertension.Biology of sex differences · 2026Article
- Predictors of Secondary Pulmonary Hypertension-Related Hospitalizations and Subsequent Mortality in Adults with Obstructive Sleep Apnea.Diseases (Basel, Switzerland) · 2026Article
- Sex-Specific Phenotypes and Outcomes in Non-Idiopathic Pulmonary Fibrosis Interstitial Lung Disease: Results from the INSIGHTS-ILD Registry.Respiration; international review of thoracic diseases · 2026Article
- Global disease burden of pulmonary arterial hypertension: patterns and inequality in 1990-2021, with projections to 2035.BMC public health · 2026Article
- Transcriptomic profiling of the sex-linked biological pathways of severe pulmonary arterial hypertension associated with endothelial cell caveolin-1 depletion and chronic hypoxia.Frontiers in physiology · 2026Article
- Sex-specific insights in atherosclerosis and pulmonary arterial hypertension: an overlooked comorbidity.Frontiers in cardiovascular medicine · 2026Review
- Pulmonary arterial compliance as a long-term prognostic indicator in pulmonary arterial hypertension associated with adult congenital heart disease: results from a National multicenter prospective registry.BMC cardiovascular disorders · 2025Article
- Low DLCO Can Provide Insights into Treatment Response in PAH Patients Irrespective of the Reason for Its Decrease.Life (Basel, Switzerland) · 2025Article
- Altered Ventilation in Rats With Established Severe Monocrotaline-Induced Pulmonary Hypertension: The Role of the Dorsal Hypothalamus.Comprehensive Physiology · 2025Article
- Attenuated benefit to vasodilators in patients with pulmonary arterial hypertension and high probability of heart failure with preserved ejection fraction.The European respiratory journal · 2025Article
- Sex differences in pulmonary (arterial) hypertension: does it matter?Current opinion in pulmonary medicine · 2025Review
- Left ventricular pressure-loading improves pressure-induced right ventricular remodeling by redistributing mechanical load and reducing mechanosignaling.Physiological reports · 2025Article
- Pressure Points: Endothelial Responses to Shear Stress and Pressure in Health and Pulmonary Arterial Hypertension.bioRxiv : the preprint server for biology · 2025Article
- SUL-150 Limits Vascular Remodeling and Ventricular Failure in Pulmonary Arterial Hypertension.International journal of molecular sciences · 2025Article
- Sex-dependent Pathophysiology and Therapeutic Considerations in Right Heart Disease.The Canadian journal of cardiology · 2025Review
- Single Test-Based Diagnosis and Subtyping of Pulmonary Hypertension Caused by Fibrosing Mediastinitis Using Plasma Metabolic Analysis.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2025Article
- Sex differences in the prevalence and survival of pulmonary hypertension in obstructive hypertrophic cardiomyopathy following septal myectomy.International journal of cardiology. Heart & vasculature · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundFemale sex is a significant risk factor for pulmonary arterial hypertension (PAH), yet males with PAH have worse survival - a phenomenon referred to as the "sex paradox" in PAH.
methodsAll adult PAH patients in the Pulmonary Hypertension Association Registry (PHAR) with congruent sex and gender were included. Baseline differences in demographics, hemodynamics, functional parameters, and quality of life were assessed by sex. Kaplan-Meier survival analysis was used to evaluate survival by sex. Mediation analysis was conducted with Cox proportional hazards regression by comparing the unadjusted hazard ratios for sex before and after adjustment for covariates. The plausibility of collider-stratification bias was assessed by modeling how large an unmeasured factor would have to be to generate the observed sex-based mortality differences. Subgroup analysis was performed on idiopathic and incident patients.
resultsAmong the 1,891 patients included, 75% were female. Compared to men, women had less favorable hemodynamics, lower 6-minute walk distance, more PAH therapies, and worse functional class; however, sex-based differences were less pronounced when accounting for body surface area or expected variability by gender. On multivariate analysis, women had a 48% lower risk of death compared to men (Hazard Ratio 0.52, 95% Confidence interval 0.36 - 0.74, p < 0.001). Modeling found that under reasonable assumptions collider-stratification could account for sex-based differences in mortality.
conclusionsIn this large registry of PAH patients new to a care center, men had worse survival than women despite having more favorable baseline characteristics. Collider-stratification bias could account for the observed greater mortality among men.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.