A disease of her own? Unique features of heart failure in women

Abstract

Heart failure (HF) is a significant and growing public health challenge for women. Compared with men, women tend to develop HF later in life and are more likely to experience HF with preserved ejection fraction. There are also significant sex differences in outcomes, with women reporting lower quality of life but overall better survival versus men. In this review, we summarize sex differences in traditional HF risk factors, such as hypertension, diabetes, obesity and coronary artery disease, as well as female-specific HF risk factors including menopause, pregnancy and adverse pregnancy outcomes, and breast cancer therapy. While our understanding of the sex-specific efficacy of HF therapy remains limited by the underrepresentation of women in major clinical trials, there is a suggestion of preferential benefit of specific agents for women. Further work is required to better understand the pathophysiology of HF in women uniquely and to increase representation of women in clinical trials.

摘要

心力衰竭（HF）对女性来说是一个重大且不断增长的公共卫生挑战。与男性相比, 女性往往在晚年才发展为心力衰竭, 并更有可能经历保留射血分数的心力衰竭。在结果方面也存在显著的性别差异, 女性报告的生活质量较低, 但总体上存活率较男性更好。在本综述中, 我们总结了传统心力衰竭风险因素（如高血压、糖尿病、肥胖和冠心病）以及女性特定的心力衰竭风险因素, 包括更年期、怀孕和不良怀孕结局, 以及乳腺癌治疗等方面的性别差异。尽管我们对于心力衰竭治疗的性别特异性的理解受到女性在主要临床试验中的代表性不足的限制, 但有迹象表明某些药物对女性具有更好的效益。需要进一步更好地理解女性心力衰竭的病理生理学独特性, 并增加女性在临床试验中的代表性。

Keywords:

• Heart failure
• cardiovascular disease
• sex differences

Potential conflict of interest

E. S. Lau reports previous advisory board service for Astellas Pharma.

Source of funding

E. S. Lau is supported by grants from National Institutes of Health [K23-HL159243]; American Heart Association [853922]; Massachusetts General Hospital [MGH SPARK Award].