Menopause-Related Estrogen Decrease and the Pathogenesis of HFpEF: JACC Review Topic of the Week

Area of Science:

• Cardiology
• Endocrinology
• Women's Health

Background:

• Heart failure (HF) is a global health issue affecting over 40 million people.
• Heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of HF cases, predominantly affecting women.
• HFpEF has high mortality (10-30% annually) and lacks targeted treatments.

Purpose of the Study:

• To explore the hypothesis that estrogen decline during menopause contributes to HFpEF pathogenesis.
• To identify potential mechanisms of estrogen action in attenuating HFpEF development.
• To highlight research needs for novel HFpEF prevention and treatment strategies.

Main Methods:

• Review and hypothesis generation based on existing literature.
• Analysis of potential estrogen-mediated pathways in cardiovascular health.
• Identification of knowledge gaps requiring further investigation.

Main Results:

• The study proposes a significant link between menopausal estrogen decline and HFpEF.
• Potential mechanisms involve estrogen's protective effects on cardiac function and vascular health.
• Significant gaps in understanding HFpEF pathophysiology and estrogen's role are identified.

Conclusions:

• Estrogen deficiency post-menopause is a plausible contributor to HFpEF development.
• Further research into estrogen's cardioprotective mechanisms is warranted.
• This understanding may lead to new therapeutic targets for HFpEF in postmenopausal women.