Sex Differences in Heart Failure: What Do We Know?

• Published in: Journal of cardiovascular development and disease 2023-06, Vol.10 (7), p.277
• Main Authors: Arata, Allegra, Ricci, Fabrizio, Khanji, Mohammed Y, Mantini, Cesare, Angeli, Francesco, Aquilani, Roberta, Di Baldassarre, Angela, Renda, Giulia, Mattioli, Anna Vittoria, Nodari, Savina, Gallina, Sabina
• Format: Article
• Language: English
• Subjects: Anemia; Biomarkers; Blood; Cardiac and Cardiovascular Systems; Cardiac function; Cardiology; Cardiovascular disease; Clinical Medicine; Comparative analysis; Coronary vessels; Diabetes; Disease prevention; Ejection fraction; Epidemiology; Estrogens; Gender differences; gender medicine; guidelines; Heart attacks; Heart failure; Hypertension; Iron; Kardiologi; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Menopause; Mortality; Nitric oxide; Obesity; Pregnancy; Review; Risk factors; sex; Sexes; Sweden; treatment; Vein & artery diseases; Womens health; World health
• ISSN: 2308-3425; 2308-3425
• DOI: 10.3390/jcdd10070277

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.