Heart failure in women

Area of Science:

• Cardiology
• Sex-Based Medicine
• Clinical Trials

Background:

• Heart failure (HF) incidence is rising globally, with women comprising approximately 50% of patients.
• Significant sex-based disparities exist in HF etiology, clinical presentation, prognosis, and treatment response.
• Hypertension is a more prevalent cause of HF in women than coronary artery disease, with HF with preserved left ventricular ejection fraction (HFpEF) being more common.

Purpose of the Study:

• To highlight the significant sex-based differences in heart failure (HF) across various aspects of the disease.
• To underscore the underrepresentation of women in HF clinical trials and its implications for evidence-based treatment.

Main Methods:

• Comparative analysis of heart failure (HF) in women versus men, examining disease etiology, expression, outcomes, and response to therapy.
• Review of existing literature and clinical trial data regarding sex differences in HF and trial participation.

Main Results:

• Women with HF exhibit distinct etiological profiles, predominantly hypertension-driven, and a higher prevalence of HFpEF.
• Despite better survival rates and lower sudden cardiac death incidence, women report poorer quality of life compared to men with similar left ventricular dysfunction.
• Animal studies confirm sex-specific differences in myocardial remodeling and function under stress.

Conclusions:

• Sex-based differences in heart failure are substantial, impacting disease mechanisms, clinical outcomes, and quality of life.
• The persistent underrepresentation of women in clinical trials (around 20%) and the lack of sex-specific subgroup analyses hinder the development of robust, evidence-based treatment guidelines for female HF patients.