Sex-Specific Differences in Heart Failure: Pathophysiology, Risk Factors, Management, and Outcomes

Sullivan, Kristen; Doumouras, Barbara S.; Santema, Bernadet T.; Walsh, Mary Norine; Douglas, Pamela S.; Voors, Adriaan A.; Spall, Harriette G.C. Van

doi:10.1016/j.cjca.2020.12.025

Cited by 55 publications

(59 citation statements)

References 100 publications

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“…There is increasing research on the protective effects of oestrogen on HF. Additionally, an oestrogen depletes postmenopausal state may contribute to women having higher left ventricular systolic and diastolic stiffness when compared to men as oestrogen is involved in blood pressure and arterial tone regulation [18]. Furthermore, the recent genetic variant analysis revealed the positive association between endogenous testosterone and HF [19,20].…”

Section: Non-ischaemicmentioning

confidence: 99%

Heart Failure with Reduced Ejection Fraction—Does Sex Matter?

Swaraj

Kozor

Arnott

et al. 2021

Curr Heart Fail Rep

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Purpose of Review There is an increasing recognition of the importance of sex in susceptibility, clinical presentation, and outcomes for heart failure. This review focusses on heart failure with reduced ejection fraction (HFrEF), unravelling differences in biology, clinical and demographic features and evidence for diagnostic and therapeutic strategies. This is intended to inform clinicians and researchers regarding state-of-the-art evidence relevant to women, as well as areas of unmet need. Recent Findings Females are well recognised to be under-represented in clinical trials, but there have been some improvements in recent years. Data from the last 5 years reaffirms that women presenting with HFrEF women are older and have more comorbidities like hypertension, diabetes and obesity compared with men and are less likely to have ischaemic heart disease. Non-ischaemic aetiologies are more likely to be the cause of HFrEF in women, and women are more often symptomatic. Whilst mortality is less than in their male counterparts, HFrEF is associated with a bigger impact on quality of life in females. The implications of this for improved prevention, treatment and outcomes are discussed. Summary This review reveals distinct sex differences in HFrEF pathophysiology, types of presentation, morbidity and mortality. In light of this, in order for future research and clinical medicine to be able to manage HFrEF adequately, there must be more representation of women in clinical trials as well as collaboration for the development of sex-specific management guidelines. Future research might also elucidate the biochemical foundation of the sex discrepancy in HFrEF.

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Section: Non-ischaemicmentioning

confidence: 99%

Heart Failure with Reduced Ejection Fraction—Does Sex Matter?

Swaraj

Kozor

Arnott

et al. 2021

Curr Heart Fail Rep

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“…HFrEF, defined as a left ventricular ejection fraction less than or equal to 40%, 60 accounts for approximately half of all cases of HF. 70 In an American midwestern epidemiologic study conducted over a decade ago, the age-and sex-adjusted incidence of HF had decreased over the decade by 37% (95% CI: -30% to -44%), more so for HFrEF (-45%; 95% CI:-33% to -55%) than HFpEF (-28%; 95% CI:-13% to -40%).…”

Section: Heart Failure With Reduced Ejection Fraction (Hfref)mentioning

confidence: 99%

“…Females are less likely than males to receive cardiac resynchronization therapy (CRT) and less likely to undergo CRT with defibrillator (CRT-D) implantation. 60,79 Slightly improved survival outcomes with CRT have been observed in females , compared to males. 80 Despite the greater benefit, females are less likely to receive device counselling than males, which may partly J o u r n a l P r e -p r o o f explain sex-differences in CRT implantation.…”

Section: Heart Failure With Reduced Ejection Fraction (Hfref)mentioning

confidence: 99%

“…73 Sex-specific HFrEF guidelines for medical management are lacking, due to the underrepresentation of females in HF trials. 60,95 Females are recruited into clinical trials at disproportionately lower rates than the HFrEF prevalence. 73 For example, female enrolment in beta-blocker trials, ARB trials, aldosterone antagonist or MRA trials, hydralazine or isosorbide dinitrate trials, angiotensin receptorneprilysin inhibitor trials, and ivabradine trials ranges from 0% to 29%.…”

Section: Representation In Clinical Trialsmentioning

confidence: 99%

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The Canadian Women’s Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 5: Sex- and Gender-Unique Manifestations of Cardiovascular Disease

et al. 2022

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“…Personen mit HI und erhaltener Pumpfunktion (HFpEF) sind zu über 50 % weiblich, Personen mit reduzierter Pumpfunktion (HFrEF) nur zu etwa 25 % [2]. Bei Ätiologie, Epidemiologie, Pathophysiologie, Symptomatik und Komorbiditäten der HI sowie bei Wirkungen, Nebenwirkungen und optimaler Dosierung von Medikamenten, beim Nutzen Device-basierter Therapien und bei der Prognose gibt es relevante Geschlechtsunterschiede, die kürzlich von der Lancet Women and Disease Commission und in mehreren Übersichten analysiert wurden, wobei sich große Wissenslücken und dringender Handlungsbedarf zeigten [2,3,4,5]. "Klassische" Risikofaktoren wie arterielle Hypertonie, Dyslipidämien oder Diabetes mellitus sind bei Frauen verglichen mit Männern mit einem teils mehrfach höheren biologischen (= sexassoziierten) Risiko für KV Ereignisse und inzidente HI assoziiert [3].…”

Section: Introductionunclassified

Geschlechtsunterschiede bei Herzinsuffizienz – Behandlung und Prognose

Angermann

Aßmus

2022

Aktuelle Kardiologie

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ZusammenfassungWeltweit sind bei Frauen kardiovaskuläre Erkrankungen die Haupttodesursache. Bei Ätiologie, Epidemiologie, Pathophysiologie, Symptomatik und Komorbiditäten der Herzinsuffizienz (HI) sowie bei Wirkungen und Nebenwirkungen von Therapiemaßnahmen und der Prognose gibt es relevante Geschlechtsunterschiede. Trotzdem sind in klinischen Studien Frauen als Teilnehmerinnen bzw. in der Studienleitung unterrepräsentiert. Sekundäre Analysen aus Therapiestudien legen Geschlechtsunterschiede bei Wirksamkeit, Nebenwirkungsprofil und optimaler Dosierung von Medikamenten und beim Nutzen von Device-Therapien nahe. Prospektive Studiendesigns mit dem Ziel, Geschlechtsunterschiede zu herauszuarbeiten, gibt es kaum, und Leitlinienempfehlungen sind meist geschlechtsneutral. Dieser Übersichtsartikel beschreibt Unterschiede bei Behandlungseffekten, Verfügbarkeit von Therapien und Krankheitsprognose, beleuchtet Wissenslücken und zeigt, wo Handlungsbedarf besteht, um die Situation von Frauen mit HI zu verbessern.

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Sex-Specific Differences in Heart Failure: Pathophysiology, Risk Factors, Management, and Outcomes

Cited by 55 publications

References 100 publications

Heart Failure with Reduced Ejection Fraction—Does Sex Matter?

Heart Failure with Reduced Ejection Fraction—Does Sex Matter?

The Canadian Women’s Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 5: Sex- and Gender-Unique Manifestations of Cardiovascular Disease

Geschlechtsunterschiede bei Herzinsuffizienz – Behandlung und Prognose

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