What have we learned so far from the sex/gender issue in heart failure? An overview of current evidence

Abstract

There are important differences in epidemiology, pathophysiology, HF patterns, prognosis, and treatment. Women have a higher incidence of HFpEF due to sex-specific factors (such as anthropometry, role of estrogens, pregnancy-related cardiomyopathies), increased incidence of comorbidities, and gender-specific conditions. Men instead present a predisposition to the development of HFrEF due to a higher incidence of coronary artery disease and myocardial infarction. However, there are still gaps in the management of women with HF. The poor inclusion of women in clinical trials may have contributed to a lesser understanding of disease behavior than in men. In addition, a full understanding of gender-specific factors that are studied in small populations is lacking in the literature, and only in recent years, studies have increased their focus on this issue. Understanding how society, family, and environment affect the prognosis of HF patients may help clinicians provide more appropriate levels of care. In this overview, we aimed at summarizing all the key available evidence regarding sex/gender differences in heart failure.

Keywords: Females; Gender; Heart failure; Males; Sex.

Fig. 1

The panels depict sex specific risk factors for women (panel A) and men (panel B). Regarding women, hypertension, obesity, and atrial fibrillation play a pivotal role. For this category a moderately high risk is also associated with hormonal status, socio-cultural and behavioral issues (gender-related variables) such as marital status, income, quality of healthcare education. Men’s outcome, on the other hand, is primarily affected by a more common ischemic etiology, higher prevalence of diabetes, and bad smoking habits. In addition, more attention should be paid to social environment, personal behaviors and education