Sex differences in the causes and natural history of heart failure

Abstract

Heart failure is a clinical syndrome of increasing prevalence in the United States, with significant morbidity and mortality. Although men have a higher annual mortality rate, more women than men die from heart failure each year. Optimal disease management is critical in limiting the impact of heart failure on life quality, quantity, and health care expenditures. Women have a unique risk-factor profile and different clinical manifestations of heart failure than men. Understanding inherent sex differences in heart failure epidemiology, pathophysiology, and natural history is imperative in determining whether the optimal therapy for this prevalent and important syndrome is affected by sex.

Patient Sex Does Not Modify Ejection Fraction as a Predictor of Death in Heart Failure: Insights from the APPROACH Cohort

“…Current convention uses the same normal EF for both sexes, but evaluating whether this is appropriate merits further investigation. 2 Further, imbalances between the sexes in EF groups and the prevalence, incidence and survival of HF should not be overlooked. 2,3 Women are more likely to develop normal EF HF, where men are more likely to develop low EF HF, 2,3 however, improvements observed in heart failure mortality have been greater in men, 3,4 and patients with low EF HF.…”

“…1 Despite this, women with HF tend to be underrepresented in clinical trials. 2,3 Many studies suggest better outcomes for women with HF, [2][3][4][5][6] although others have found similar outcomes. 7,8 Well-recognized sex differences in HF patients could potentially lead to sex differences in HF outcomes.…”

“…7,8 Well-recognized sex differences in HF patients could potentially lead to sex differences in HF outcomes. 2,3 Female HF patients tend to be older, have more hypertension, and less coronary artery disease than their male counterparts. 2,3 Women with HF may be treated differently than men.…”

“…2,3 Female HF patients tend to be older, have more hypertension, and less coronary artery disease than their male counterparts. 2,3 Women with HF may be treated differently than men. 5,7 Most importantly, women with HF are more likely to have a normal ejection fraction (EF), while men with HF are more likely to have a low EF.…”

“…5,7 Most importantly, women with HF are more likely to have a normal ejection fraction (EF), while men with HF are more likely to have a low EF. 2,3,8 Normal and low EF HF have several key differences. 9 The phrase 'normal EF HF' is often used interchangeably with 'diastolic HF' or 'HF with preserved systolic function', although the need for further measures of diastolic function to confirm the latter diagnoses is controversial.…”