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Sex and gender differences in myocardial hypertrophy and heart failure
Vera Regitz-Zagrosek1, Sabine Oertelt-Prigione, Ute Seeland
1Institute of Gender in Medicine and Center for Cardiovascular Research, Charité University Medicine Berlin, Germany. vera.regitz-zagrosek@charite.de
Insights
Heart failure (HF) affects men earlier than women, with distinct types and risk factors. Despite receiving less optimal care, women with HF generally experience a better prognosis than men.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Sex Differences in Heart Disease
Background:
- Heart failure (HF) is a major cause of death and illness globally.
- Sex-based disparities exist in HF prevalence, type, and progression.
- Hormonal and cellular mechanisms contribute to sex differences in cardiac response to stress.
Purpose of the Study:
- To delineate the sex-specific differences in heart failure pathophysiology and clinical outcomes.
- To investigate the impact of sex on cardiac remodeling, energy metabolism, and response to stress.
- To evaluate disparities in diagnostics, therapy, and prognosis between men and women with HF.
Main Methods:
- Comparative analysis of epidemiological data on heart failure in men and women.
- Review of studies examining sex differences in cardiac structure and function under stress.
- Analysis of hormonal influences (estrogens, androgens) on myocardial pathways.
- Examination of sex-based differences in atrial fibrillation, auto-antibody presence, and treatment utilization.
Main Results:
- Men experience HF at younger ages, often with systolic dysfunction due to coronary artery disease.
- Women more commonly present with diastolic HF, linked to diabetes and hypertension, and show better cardiac reversibility.
- Female hearts exhibit superior energy metabolism and calcium overload protection under stress.
- Atrial fibrillation is a worse prognostic indicator in women; men show higher auto-antibody levels in end-stage cardiomyopathy.
Conclusions:
- Significant sex-based differences exist in heart failure development, response to stress, and clinical presentation.
- Women with HF face underutilization of guideline-based diagnostics and therapies, despite a generally better prognosis.
- Further research is needed to optimize HF management considering sex-specific factors.
Abstract:
Heart failure (HF) is a leading cause of cardiovascular mortality and morbidity in the Western world. It affects men at younger age than women. Women have more frequently diastolic HF, associated with the major risk factors of diabetes and hypertension and men have more frequently systolic HF because of coronary artery disease. Under stress, male hearts develop more easily pathological hypertrophy with dilatation and poor systolic function than female hearts. Women with aortic stenosis have more concentric hypertrophy with better systolic function, less upregulation of extracellular matrix genes and better reversibility after unloading. Stressed female hearts maintain energy metabolism better than male hearts and are better protected against calcium overload. Estrogens and androgens and their receptors are present in the myocardium and lead to coordinated regulation of functionally relevant pathways. Atrial fibrillation (AF) is a more ominous sign in women than in men. Men with end-stage cardiomyopathy more frequently have auto-antibodies than women. Women receive less guideline-based diagnostics and therapy. Expensive and invasive therapies such as advanced pacemakers and transplantation are underused in women. Drug studies point at sex differences in efficacy. Despite worse diagnostics and therapy, prognosis is better in women than in men.
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