Sex differences in factors associated with heart failure and diastolic left ventricular dysfunction: a cross-sectional population-based study

Abstract

Background Although sex differences in cardiovascular diseases are recognised, including differences in incidence, clinical presentation, response to treatments, and outcomes, most of the practice guidelines are not sex-specific. Heart failure (HF) is a major public health challenge, with high health care expenditures, high prevalence, and poor clinical outcomes. The objective was to analyse the sex-specific association of socio-demographics, life-style factors and health characteristics with the prevalence of HF and diastolic left ventricular dysfunction (DLVD) in a cross-sectional population-based study. Methods A random sample of 2001 65–84 year-olds underwent physical examination, laboratory measurements, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), electrocardiography, and echocardiography. We selected the subjects with no missing values in covariates and echocardiographic parameters and performed a complete case analysis. Sex-specific multivariable logistic regression models were used to identify the factors associated with the prevalence of the diseases, multinomial logistic regression was used to investigate the factors associated to asymptomatic and symptomatic LVD, and spline curves to display the relationship between the conditions and both age and NT-proBNP. Results In 857 men included, there were 66 cases of HF and 408 cases of DLVD (77% not reporting symptoms). In 819 women, there were 51 cases of HF and 382 of DLVD (79% not reporting symptoms). In men, the factors associated with prevalence of HF were age, ischemic heart disease (IHD), and suffering from three or more comorbid conditions. In women, the factors associated with HF were age, lifestyles (smoking and alcohol), BMI, hypertension, and atrial fibrillation. Age and diabetes were associated to asymptomatic DLVD in both genders. NT-proBNP levels were more strongly associated with HF in men than in women. Conclusions There were sex differences in the factors associated with HF. The results suggest that prevention policies should consider the sex-specific impact on cardiac function of modifiable cardiovascular risk factors.

Gender-Specific Long-Term Prognostic Values of QRS Duration, QT Interval, and QTc from Automated ECG Analysis for Mortality and Adverse Outcomes in Patients Hospitalized for Heart Failure

“…We showed important differences in clinical outcomes between sexes. Previous studies have demonstrated sex differences in clinical outcomes (21), and the reasons underlying such differences are multi-faceted, including genetic and aetiological differences, as well as different responses to pharmacotherapy (22)(23)(24). Importantly, analyses have demonstrated significant underrepresentation of women in clinical trials, which likely impacts the efficacy of guideline-driven medical therapy in female patients with heart failure (25).…”

Phenotypic and Functional Heterogeneity of Monocyte Subsets in Chronic Heart Failure Patients

“…The debate about sex as an additional risk factor for HF development has also been reported [ 12 ]. The factors associated with HF in men were age, ischemic heart disease, and comorbidities, whereas in women, a combination of lifestyle factors, age, body mass index, hypertension, and atrial fibrillation was found to be of greatest importance [ 12 ].…”

“…The debate about sex as an additional risk factor for HF development has also been reported [ 12 ]. The factors associated with HF in men were age, ischemic heart disease, and comorbidities, whereas in women, a combination of lifestyle factors, age, body mass index, hypertension, and atrial fibrillation was found to be of greatest importance [ 12 ]. It seems that HFrEF as a main result of ischemic heart disease would dominate in men, while HFpEF as a result of increased body mass index and hypertension would dominate in women.…”

“…Monocytes are grouped according to the relative expression levels of their CD14 and CD16 surface proteins and chemokine receptors, as well as their phagocytic activity [11]. No expression is defined as "−", moderate expression is defined as "+", and high expression is defined as "++" [12]. Monocyte subsets also differ in their combinations of adhesion molecules and chemokine receptors, upon which different monocyte functions depend.…”

Sex Differences in Cardiovascular Diseases: A Matter of Estrogens, Ceramides, and Sphingosine 1-Phosphate

“…Sex differences have been observed in cardiovascular diseases (CVD), ultimately leading to heart failure (HF) development and prognosis, but the underlying mechanisms remain unclear [ 1 , 2 ]. In animals and humans with cardiac disease, females display lower mortality, less severe disease phenotype, and faster cardiac repair than their male counterparts [ 3 , 4 , 5 , 6 ].…”