Sex Influence on Heart Failure Prognosis

Abstract

Heart failure (HF) affects 1–2% of the population in developed countries and ~50% of patients living with it are women. Compared to men, women are more likely to be older and suffer hypertension, valvular heart disease, and non-ischemic cardiomyopathy. Since the number of women included in prospective HF studies has been low, much information regarding HF in women has been inferred from clinical trials observations in men and data obtained from registries. Several relevant sex-related differences in HF patients have been described, including biological mechanisms, age, etiology, precipitating factors, comorbidities, left ventricular ejection fraction, treatment effects, and prognosis. Women have greater clinical severity of HF, with more symptoms and worse functional class. However, females with HF have better prognosis compared to males. This survival advantage is particularly impressive given that women are less likely to receive guideline-proven therapies for HF than men. The reasons for this better prognosis are unknown but prior pregnancies may play a role. In this review article we aim to describe sex-related differences in HF and how these differences might explain why women with HF can expect to survive longer than men.

Gender Distribution in Randomized Controlled Trials among Patients with Heart Failure with Reduced Ejection Fraction: A Systematic Review

“…In this systematic review of 706 trials, we identified significant under-representation of women in HFrEF trials .This appears to be in line with the findings of similar analyses of heart failure trials [3], and acute coronary syndrome (ACS) trials (26.8% of women subjects) [4]. Under-enrolment of women puts the generalizability of these trials' findings into question, as it is well known that there are sex-based differences in heart failure aetiologies, co-morbidities, prognosis as well as responses to treatments [5]. It is, however, reassuring to some extent that the recruitment of female participants has improved towards the later part of the decade.…”

The Bioinformatical Identification of Potential Biomarkers in Heart Failure Diagnosis and Treatment

“…HF is characterized by a poor prognosis [ 20 ]. The prognostic factors of HF are mainly related to age, gender, physical fitness, etiology, ventricular ejection fraction, and cardiac function [ 21 ]. HF patient groups have significant differences in etiology, pathophysiology, and natural disease progression [ 22 ].…”

5-HTT Deficiency in Male Mice Affects Healing and Behavior after Myocardial Infarction

“…Due to established echocardiographic criteria, we could monitor CCD development in young adult male 5-HTT mice with and without experimentally induced MI, and shed light on the consequences of 5-HTT deficiency on post-MI anxiety- and depression-like behaviors by means of ethologically relevant paradigms. In the general population, however, depression is more common in women than men, and prevalence rates are also higher in female CHF patients, albeit male sex predicts poorer outcomes [ 72 , 73 ]. Thus, further studies including female cohorts are warranted to decipher potential sex-specific (e.g., estrogen-driven) mechanisms regulating MI-induced cardiac remodeling and its impact on behavior due to defective 5-HTT neurotransmission.…”