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Published on: April 17, 2021
Gender differences in the pathophysiology, clinical presentation, and outcomes of ischemic heart failure
Shannon M Dunlay1, Véronique L Roger
1Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Women with heart failure (HF) after myocardial infarction (MI) face unique risks and benefits compared to men. Understanding these sex differences is crucial for developing effective, tailored treatments for ischemic heart disease outcomes.
Area of Science:
- Cardiovascular Medicine
- Sex Differences in Disease
Background:
- Heart failure (HF) is a common outcome of ischemic heart disease (IHD) despite advances in acute myocardial infarction (MI) treatment.
- Women exhibit distinct responses to myocardial ischemia, including relative protection from apoptosis and less adverse cardiac remodeling compared to men.
Purpose of the Study:
- To review and highlight the sex differences in the pathophysiology, clinical presentation, and outcomes of ischemic heart failure (HF).
- To discuss key areas for future research in sex-specific HF treatment.
Main Methods:
- Review of existing literature on sex differences in ischemic heart failure.
- Analysis of clinical trial data regarding women's representation and treatment responses.
Main Results:
- Women have a higher risk of HF post-MI but retain a survival advantage over men with HF, including reduced sudden death risk.
- Historical under-representation of women in trials has impeded sex-specific HF treatment development.
- Emerging evidence suggests differential responses to therapies like cardiac resynchronization in women.
Conclusions:
- Significant sex differences exist in ischemic heart failure, impacting risk, presentation, and outcomes.
- Further investigation into these sex-specific aspects is essential for advancing HF management.
- Tailoring HF therapies based on sex may improve patient outcomes.
Abstract:
Despite advances in the treatment of acute myocardial infarction (MI), heart failure (HF) remains a frequent acute and long-term outcome of ischemic heart disease (IHD). In response to acute coronary ischemia, women are relatively protected from apoptosis, and experience less adverse cardiac remodeling than men, frequently resulting in preservation of left ventricular size and ejection fraction. Despite these advantages, women are at increased risk for HF- complicating acute MI when compared with men. However, women with HF retain a survival advantage over men with HF, including a decreased risk of sudden death. Sex-specific treatment of HF has been hindered by historical under-representation of women in clinical trials, though recent work has suggested that women may have a differential response to some therapies such as cardiac resynchronization. This review highlights the sex differences in the pathophysiology, clinical presentation and outcomes of ischemic heart failure and discusses key areas worthy of further investigation.
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