Gender aspects in heart failure. Pathophysiology and medical therapy

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Heart failure (HF) exhibits significant gender-based variations in etiology, pathophysiology, clinical presentation, and disease course.
• Hypertension and diabetes are key HF contributors in women, interacting with the renin-angiotensin system (RAS).
• Estrogen's modulation of the RAS contributes to gender-specific differences, particularly between pre- and post-menopausal women and men.

Purpose of the Study:

• To explore gender-specific differences in heart failure (HF) etiology, pathophysiology, and clinical presentation.
• To analyze gender-based responses to HF therapies and physician treatment behaviors.
• To investigate the implications of gender and hormonal status on RAS modulation and HF management.

Main Methods:

• Review of existing literature on gender differences in heart failure.
• Analysis of pathophysiological mechanisms including myocardial growth, calcium handling, and remodeling.
• Examination of clinical trial data and post-hoc analyses focusing on gender-specific treatment outcomes.

Main Results:

• HF with preserved systolic function is more prevalent in women; clinical course of systolic HF differs between genders.
• Gender-specific analyses in large trials have been neglected, leading to delayed recognition of adverse effects (e.g., digitalis in women).
• While some therapies like ACE inhibitors show gender-specific side effect profiles and efficacy, ARBs are well-tolerated. RAS inhibition may benefit postmenopausal women.

Conclusions:

• Gender significantly influences HF development, progression, and response to treatment.
• Current HF therapies are often not gender-tailored, necessitating further research and specific analyses.
• Understanding gender-based mechanisms, especially RAS modulation, is vital for optimizing HF management, particularly in postmenopausal women.