Differential Impact of Heart Failure With Reduced Ejection Fraction on Men and Women

Dewan, Pooja; Rørth, Rasmus; Jhund, Pardeep S.; Shen, Li; Raparelli, Valeria; Petrie, Mark C.; Abraham, William T.; Desai, Akshay S.; Dickstein, Kenneth; Køber, Lars; Mogensen, Ulrik M.; Packer, Milton; Rouleau, Jean L.; Solomon, Scott D.; Swedberg, Karl; Zile, Michael R.; McMurray, John J.V.

doi:10.1016/j.jacc.2018.09.081

Cited by 205 publications

(192 citation statements)

References 34 publications

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“…112,113 In the clinical setting, evidence regarding the association of endogenous female sex hormones with higher cardiac NP levels is limited; some studies, however, indicate that exogenous female hormone therapy may contribute to higher cardiac NP levels. 25,114 In HF patients, sex differences in cardiac NP levels are inconsistent, [46][47][48][49] and on an average, their levels appear to be slightly higher in men ( Figure 3B). This suggests that in diseased states associated with massive cardiac NP production, such as HF, more 'subtle' effects of sex hormones are overridden, and plasma levels may no longer reflect sex-specific changes.…”

Section: Unlikelymentioning

confidence: 98%

Sex‐related differences in contemporary biomarkers for heart failure: a review

Suthahar

Meems

et al. 2020

European J of Heart Fail

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The use of circulating biomarkers for heart failure (HF) is engrained in contemporary cardiovascular practice and provides objective information about various pathophysiological pathways associated with HF syndrome. However, biomarker profiles differ considerably among women and men. For instance, in the general population, markers of cardiac stretch (natriuretic peptides) and fibrosis (galectin‐3) are higher in women, whereas markers of cardiac injury (cardiac troponins) and inflammation (sST2) are higher in men. Such differences may reflect sex‐specific pathogenic processes associated with HF risk, but may also arise as a result of differences in sex hormone profiles and fat distribution. From a clinical perspective, sex‐related differences in biomarker levels may affect the objectivity of biomarkers in HF management because what is considered to be ‘normal’ in one sex may not be so in the other. The objectives of this review are, therefore: (i) to examine the sex‐specific dynamics of clinically relevant HF biomarkers in the general population, as well as in HF patients; (ii) to discuss the overlap between sex‐related and obesity‐related effects, and (iii) to identify knowledge gaps to stimulate research on sex‐related differences in HF.

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Section: Unlikelymentioning

confidence: 98%

Sex‐related differences in contemporary biomarkers for heart failure: a review

Suthahar

Meems

et al. 2020

European J of Heart Fail

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“…As shown in Table 1, women have a lower prevalence of non-cardiovascular co-morbidities compared to men with the notable exception of depressive disorder, which is significantly more prevalent in women. 18 Almost half of women with HF self-reported moderate to extreme anxiety or depression based on the 3-level EuroQol-5 Dimensions (EQ-5D-3L) assessment. 19 Furthermore, women have been found to score lower on the Kansas City Cardiomyopathy Questionnaire (KCCQ) clinical summary and functional limitation score compared to men.…”

mentioning

confidence: 99%

Considering the gender gap in heart failure

Lin

Greenberg

2019

European J of Heart Fail

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Recognition that heart failure (HF) is a major global health problem has led to widespread study of its causes, underlying mechanisms, associated co-morbidities and clinical characteristics. Most importantly, it has resulted in the development of therapies that greatly improve outcomes, particularly for patients with HF with reduced ejection fraction (HFrEF). Progress in understanding and treating HF, however, has been uneven with less robust advances seen in some areas than in others. One area that is lagging is the understanding of differences between men and women in several facets of HF, including pathophysiology, clinical presentation, management decisions and response to therapy. In this issue of the Journal, Frigerio and colleagues present an interesting case of a patient in whom the diagnosis and treatment of HF were greatly delayed. 1 While their lucid discussion attributes this to the patient's past history, her young age, and the presence of somewhat atypical symptoms, it is also possible that the patient's sex played a role. In this article, we discuss some of the gender differences in HF and their clinical implications.As summarized in Table 1, 2-6 there are important differences between men and women in the prevalence of risk factors for HF. Coronary artery disease (CAD) is, in general, the most strongly associated risk factor for HF with a population attributable risk (PAR) of 61%. 7 When gender differences are incorporated, however, the PAR for CAD is more than doubled in men compared to women at 39% and 18%, respectively. 8 In contrast, the PAR for hypertension, another common risk factor for HF, is higher in women than for men (59% compared to 39%). 8 Hypertension disproportionately affects women after the age of 65 years, with a threefold increase in risk of developing HF in this group, compared to a twofold increase in risk in men. 8 These differences play a role in determining well known sex and age differences in HF phenotype with HFrEF being more common and presenting at a younger age in males while HF with preserved ejection fraction (HFpEF) is more common in older women. Moreover, there is an interaction between sex and development of HF for some risk factors. Although diabetes mellitus is more common in men than in women, it has been associated with a fivefold increase in HF risk in women compared to only a twofold increase in risk in men. 9 In women with CAD, diabetes has been identified as the strongest predictor of HF. 10 Differences in the prevalence of risk factors have *Corresponding author. Advanced Heart Failure Treatment Program,

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“…Data from the Framingham study suggest that all‐cause mortality from heart failure is decreasing . Some studies have shown a parallel decrease in mortality in both sexes or even improved outcomes in women, especially in NICM . Unfortunately, it has also been reported that this positive trend exists in men but not in women .…”

Section: Discussionmentioning

confidence: 99%

Impact of sex, socio‐economic status, and remoteness on therapy and survival in heart failure

et al. 2019

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Aims This study aims to determine if traditional markers of disadvantage [female sex, low socio-economic status (SES), and remoteness] are associated with lower prescription of evidence-based therapy and higher mortality among patients with moderate-severe heart failure with reduced ejection fraction. Methods and resultsWe recruited 452 consecutive class II-III heart failure with reduced ejection fraction patients. Baseline clinical data were recorded prospectively. The primary outcome was the association of female sex on overall survival. Secondary outcomes included association between evidence-based therapy delivery and sex and association of SES and remoteness on heart failure therapy and survival. The Australian Bureau of Statistics generated all indices. Median follow-up was 37.9 months. One hundred and nine patients (24.3%) were women. There was no difference in overall survival based on sex (hazard ratio = 1.19, 95% confidence interval: 0.74-1.92, 0.48). There was no difference in prescription of beta-blockers [χ 2 (1) = 0.91, 0.66], angiotensin-converting enzyme inhibitors [χ 2 (1) = 0.001, 0.97], nor aldosterone antagonists [χ 2 (1) = 2.71, 0.10]. There was no difference in rates of primary prevention implantable cardioverter-defibrillator implantation in men compared with women [χ 2 (1) = 0.35, 0.56]. Neither higher SES nor inner city residence conferred an overall survival benefit. Conclusions In this Australian cohort of heart failure patients, delivery of care and likelihood of death are comparable between the sexes, SES groups, and rural vs. city residents.

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Differential Impact of Heart Failure With Reduced Ejection Fraction on Men and Women

Cited by 205 publications

References 34 publications

Sex‐related differences in contemporary biomarkers for heart failure: a review

Sex‐related differences in contemporary biomarkers for heart failure: a review

Considering the gender gap in heart failure

Impact of sex, socio‐economic status, and remoteness on therapy and survival in heart failure

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