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Left ventricular hypertrophy and heart failure in women
Enrico Agabiti-Rosei1, Maria Lorenza Muiesan
1University of Brescia, c/o Spedali Civili, 2o Medicina generale, Brescia 25100, Italy. agabiti@master cci.unibs.it
Insights
Left ventricular hypertrophy (LVH) is a key predictor of cardiovascular events. Reducing LVH through antihypertensive treatment is crucial, especially in women, though more research is needed on sex-specific strategies.
Area of Science:
- Cardiology
- Hypertension Research
- Sex Differences in Cardiovascular Disease
Background:
- Left ventricular hypertrophy (LVH) is a significant predictor of cardiovascular morbidity and mortality, independent of blood pressure.
- While less prevalent in women than men at similar blood pressure levels, LVH incidence increases with age and post-menopause.
- Hypertension and LVH pose greater risks for stroke and heart failure in women compared to men.
Purpose of the Study:
- To review the current understanding of left ventricular hypertrophy (LVH) in cardiovascular disease.
- To highlight the importance of LVH regression as a treatment goal in hypertension.
- To examine the available data on antihypertensive therapy effects on LVH, with a focus on sex differences.
Main Methods:
- Literature review of studies on left ventricular hypertrophy (LVH) and cardiovascular outcomes.
- Analysis of data concerning the impact of antihypertensive treatments on LVH regression.
- Examination of sex-specific differences in LVH prevalence, risk, and treatment response.
Main Results:
- LVH regression through antihypertensive treatment is associated with reduced cardiovascular events.
- Antihypertensive drug classes may differentially affect LVH beyond blood pressure control.
- Data on LVH treatment in women are limited, with potential influences from hormonal status and trial underrepresentation.
Conclusions:
- Reversal of LVH is a critical therapeutic objective for hypertensive patients.
- Further research is needed to clarify sex-specific benefits of LVH regression and tailor therapeutic strategies for women.
- Understanding the role of factors like estrogen and ensuring adequate female participation in trials are essential for advancing care.
Abstract:
The importance of left ventricular hypertrophy (LVH) as a powerful predictor of cardiovascular morbidity and mortality, independent from blood pressure and other cardiovascular risk factors, is widely recognized. Women have a lower prevalence of LVH than men for any given level of blood pressure. The occurrence of LVH increases progressively with older age and LVH becomes more common in women after menopause. Available data indicate that both hypertension and LVH are stronger risk factors for stroke and for heart failure in women than in men. Women are more likely to maintain a better left ventricular systolic function than men with similar heart failure symptoms, and heart failure due to diastolic dysfunction is more common in women than in men. Few studies have demonstrated that patients who fail to achieve a reduction of LVH are much more likely to suffer cardiovascular events than those in whom the left ventricular mass is reduced by antihypertensive treatment. Reversal of LVH therefore represents a major goal in the treatment of hypertensive patients. The degree of cardiac hypertrophy reduction is influenced by baseline severity of LVH, by the duration of treatment and by the degree of 24-h blood pressure control. In addition, beyond the control of blood pressure, different classes of antihypertensive drugs may differently interfere with several non-hemodynamic stimuli, and therefore have a different effect on left ventricular mass. Data regarding the effect of antihypertensive therapy on LVH in women are not adequate. Few studies have suggested a possible additive effect of estrogen replacement therapy on left ventricular mass changes in hypertensive postmenopausal women. Many of the major heart failure intervention trials did not include women or had only a small proportion of female patients. In the SAVE, AIRE, TRACE and SOLVD trials, treatment with angiotensin-converting enzyme inhibitors resulted in similar benefit to women and in men. In studies evaluating the effect of beta-blocker treatment in patients with heart failure, the benefit was statistically significant in men but not in women. Results from further multicenter ongoing trials are awaited to definitely evaluate whether regression of LVH carries a similar benefit in women and men, and whether different therapeutic strategies may be applied to women to regress LVH and to prevent the progression to heart failure.