Comorbidities in Heart Failure: Are There Gender Differences?

Abstract

Compared to men, women with heart failure (HF) are often older, smoke less, and have more preserved ejection fraction (EF) and hypertensive HF rather than HF of ischemic etiology. Gender-stratified outcomes on comorbidities data in HF are scarce. Women have traditionally been underrepresented in HF trials. Although data suggest that overall prognosis may be better in women, they experience lower quality of life with greater functional impairment from HF compared to men. Gender differences have been reported for comorbid diabetes, chronic obstructive pulmonary disease, renal dysfunction, anemia, and depression and may explain gender disparity in outcomes. However, possible confounding of comorbidities with known prognostic determinants in HF (such as EF) as well as gender differences in the utilization of medical therapies obscures interpretation. In this review, we will explore the evidence for gender differences in non-cardiovascular comorbidities in HF. Our findings may guide clinicians to individualize HF care, according to best practice, in the hope of improving prognosis for this chronic and debilitating condition.

Sex differences in outcomes of heart failure in an ambulatory, population-based cohort from 2009 to 2013

“…Men with heart failure are more often smokers and more likely to have MI, COPD and heart failure with reduced ejection fraction. 34 Our findings are consistent across many of these comorbidities; however, we found lung disease to be more common in women. Whether this is due to sex differences in smoking rates, and uptake and compliance with smoking cessation programs is not known.…”

Sex-Specific Differences in New York Heart Association Classification and Outcomes of Decompensated Heart Failure

“…Concurrent medical comorbidities, such as respiratory diseases and obesity, may also affect interpretation of symptom severity. 6 For chronic HF with reduced ejection fraction (HFrEF), studies have found that NYHA class IV compared with NYHA class III is a predictor of mortality in women but in not men. 7 This raises the possibility that the underlying pathophysiology and risk factors for HF may be sex specific.…”

Sex Differences in Comorbidity, Therapy, and Health Services’ Use of Heart Failure in Spain: Evidence from Real-World Data

“…There are, however, controversies regarding the effect of sex on the prevalence of chronic renal failure and diabetes, with contradictory results in the literature [25,32,[36][37][38][39]. The significant differences shown in COPD prevalence could be associated with higher levels of tobacco use in men [6,11,25], since toxic habits were clearly more frequent in men (although probably under-registered), as previously reported in the literature [8,11,26]. On the other hand, women were more likely to suffer conditions such as depression, osteoporosis, osteoarticular pathology, varicose veins, hypothyroidism, and asthma.…”

“…Heart failure presents, in most cases, as a chronic disease with a high burden of comorbidities, some of which seem to be sex-specific [6]. Whereas women are more likely to present comorbid hypertension, diabetes, hypothyroidism, obesity, and depression, men tend to have more peripheral vascular disease, ischemic heart disease and chronic obstructive pulmonary disease (COPD) [9,11,12]. The overall constellation of comorbidities surrounding HF may play an important role not only in the pathophysiology, but also in the treatment and prognosis of the disease [13].…”

“…Combined efforts from different stakeholders (e.g., researchers, health authorities, and registry administrators) are required to adequately fill our knowledge gap on sex differences in HF [11]. In this context, the increasing availability for research of real-world, routinely collected health data obtained during the care process (e.g., electronic health records-EHRs) represents a unique opportunity to conduct clinical-epidemiological, large-scale population studies and provide us with real-world evidence on sex differences in HF.…”