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Heart Failure Subtypes and Cardiomyopathies in Women

Ersilia M DeFilippis1, Anna Beale2, Trejeeve Martyn3

  • 1Division of Cardiology, Columbia University Irving Medical Center (E.M.D.).

Circulation Research
|February 17, 2022
PubMed

Insights

This review explores sex differences in heart failure, highlighting how hormones and bias impact women and men differently. Understanding these disparities is crucial for improving diagnosis and treatment outcomes in cardiovascular disease.

Area of Science:

  • Cardiology
  • Reproductive Endocrinology
  • Health Disparities

Background:

  • Heart failure impacts millions in the US, with significant sex-based variations in occurrence, progression, and treatment effectiveness.
  • Specific cardiomyopathies like peripartum, hypertrophic, and stress-induced heart failure exhibit distinct sex-related epidemiological and clinical profiles.
  • Cellular mechanisms involving sex hormones and societal factors like implicit bias contribute to observed sex differences in heart failure.

Purpose of the Study:

  • To conduct a comprehensive narrative review of recent literature (last decade) on sex differences in heart failure.
  • To examine pathophysiological insights and clinical practice variations related to sex in heart failure syndromes.
  • To consolidate current knowledge on sex-specific aspects of various cardiomyopathies.

Main Methods:

  • Systematic literature search of studies published within the last 10 years.
  • Narrative synthesis of findings related to sex differences in heart failure epidemiology, pathophysiology, and clinical management.
  • Inclusion of diverse cardiomyopathies, including peripartum, hypertrophic, stress, amyloidosis, and sarcoidosis.

Main Results:

  • Identified sex-specific effects of hormones on the renin-angiotensin-aldosterone system, vascular aging, and cardiac remodeling.
  • Highlighted how implicit bias contributes to undertreatment and underrepresentation of women in clinical trials.
  • Documented disparities in response to treatment and outcomes across different heart failure types based on sex.

Conclusions:

  • Sex is a critical determinant in heart failure, influencing disease mechanisms and clinical presentation.
  • Addressing cellular sex hormone effects and mitigating implicit bias are essential for equitable heart failure care.
  • Further research and inclusive clinical trial designs are needed to optimize heart failure management for all sexes.

Keywords:
cardiomyopathiesestrogensheart failureperipartumwomen

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