Sex Differences in Heart Failure: What Do We Know?

Abstract

Heart failure (HF) remains an important global health issue, substantially contributing to morbidity and mortality. According to epidemiological studies, men and women face nearly equivalent lifetime risks for HF. However, their experiences diverge significantly when it comes to HF subtypes: men tend to develop HF with reduced ejection fraction more frequently, whereas women are predominantly affected by HF with preserved ejection fraction. This divergence underlines the presence of numerous sex-based disparities across various facets of HF, encompassing aspects such as risk factors, clinical presentation, underlying pathophysiology, and response to therapy. Despite these apparent discrepancies, our understanding of them is far from complete, with key knowledge gaps still existing. Current guidelines from various professional societies acknowledge the existence of sex-based differences in HF management, yet they are lacking in providing explicit, actionable recommendations tailored to these differences. In this comprehensive review, we delve deeper into these sex-specific differences within the context of HF, critically examining associated definitions, risk factors, and therapeutic strategies. We provide a specific emphasis on aspects exclusive to women, such as the impact of pregnancy-induced hypertension and premature menopause, as these unique factors warrant greater attention in the broader HF discussion. Additionally, we aim to clarify ongoing controversies and knowledge gaps pertaining to the pharmacological treatment of HF and the sex-specific indications for cardiac implantable electronic devices. By shining a light on these issues, we hope to stimulate a more nuanced understanding and promote the development of more sex-responsive approaches in HF management.

Myocardial strain of the left ventricle by speckle tracking echocardiography: From physics to clinical practice

“…On the other side, HF with preserved EF (HFpEF) is still a challenging diagnosis for clinicians 218,219 . As LV hypertrophy is frequently observed in patients with HFpEF, 220 LV GLS is a useful tool to discriminate between physiological and pathological hypertrophy and its regional patterns could help differentiating among different pathological conditions 220,221 .…”

“…216,217 On the other side, HF with preserved EF (HFpEF) is still a challenging diagnosis for clinicians. 218,219 As LV hypertrophy is frequently observed in patients with HFpEF, 220 LV GLS is a useful tool to discriminate between physiological and pathological hypertrophy and its regional patterns could help differentiating among different pathological conditions. 220,221 LV GLS evaluation is recommended in the diagnostic work up for HFpEF by the European Society of Cardiology's Heart failure Association, despite being included as minor criterion in the HFA-PEFF diagnostic score.…”

Cardiovascular risk stratification in young women: the pivotal role of pregnancy

“…Inflammation plays a crucial role in the development of endothelial dysfunction, which can impair blood vessel function and contribute to cardiovascular complications. Chronic inflammation can persist beyond pregnancy, leading to long-term vascular damage and promoting the development of HFpEF 50 …”

“…Excessive ROS can cause damage to blood vessels and impair the function of the heart. Oxidative stress, if not properly balanced by antioxidants, can contribute to the progression of CVDs, including HFpEF 50 …”

“…The vascular changes that occur during pregnancy may accelerate vascular biological aging, leading to stiffer and less elastic blood vessels. Vascular aging can contribute to increased vascular resistance and impaired diastolic function, which are characteristic features of HFpEF 50 …”