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Gender differences in the etiology of heart failure: A systematic review
Nahid Azad1, Anusha Kathiravelu, Shabnam Minoosepeher
1Department of Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.
Insights
Gender disparities exist in heart failure (HF) etiology. Men show more systolic dysfunction and ischemic heart disease, while women face higher HF risk with systolic hypertension. Further research is needed.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Heart failure (HF) is a growing concern in aging populations, particularly affecting women.
- Understanding HF etiology is crucial for effective treatment selection and outcomes.
- Existing studies suggest potential gender variations in HF morbidity and mortality, possibly linked to etiological factors.
Purpose of the Study:
- To systematically review and assess the evidence for gender differences in the causes of chronic heart failure.
- To identify specific etiological factors associated with heart failure in men and women.
Main Methods:
- A comprehensive literature search was conducted from 1980 to 2009 using Medline, EMBASE, and PubMed.
- 2,347 abstracts were screened, with 35 original articles meeting inclusion criteria for review.
- Data were extracted from observational studies (cohort or cross-sectional) with an average 3-month follow-up.
Main Results:
- Ventricular systolic dysfunction was more prevalent in males; females were more often associated with preserved left ventricular function.
- Ischemic heart disease was a strong etiological factor correlated with male sex.
- Women had a significantly elevated risk for HF with systolic hypertension, while diabetes mellitus showed an equal association in both sexes.
Conclusions:
- Many clinical trials lack gender analysis or sufficient power due to underrepresentation of women, limiting conclusions on cardiovascular disease gender differences.
- There is a clear need for well-designed prospective studies with adequate male and female cohorts.
- Future research should analyze etiology and risk factors, specifically addressing sex-based differences in heart failure.
Background:
Heart failure (HF) is an increasing problem for the aging population, specifically among women. The etiology of HF influences both the selection and outcome of the treatment. There are variations between genders in morbidity and mortality in different studies, possibly reflecting etiology. The objective of this study was to examine the strength of evidence available for gender differences in the etiology of chronic heart failure.
Methods:
Computer-assisted searches from 1980-2009 for gender differences in the etiology of heart failure were performed (Medline, EMBASE and PubMed). From 2347 abstracts reviewed based on inclusion criteria, 35 original articles were chosen for review. Data extraction was based on observational studies (prospective/retrospective cohort or cross sectional) with a mean follow up of 3 months. There was no interrater variability between the 2 reviewers on data-extraction.
Results:
Ventricular systolic dysfunction being more associated with male sex, but female sex was more reported to be associated with preserved left ventricular function. Ischemic etiology and associated coronary heart disease were strongly correlated with male sex. The risk for HF was dramatically more elevated for women with systolic hypertension but the association for diabetes mellitus as the etiology of HF was somewhat equal between males and females.
Conclusions:
One of the limitations in reaching conclusions about gender differences in cardiovascular disease is that many major clinical trials do not include a gender analysis nor they are powered to do so as women are under-represented in most of the HF studies. The need remains for a well designed prospective study of sufficient numbers of male and female patients with and without heart failure and analyzing etiology and risk factors based on the sex differences.
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