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Sex differences and related estrogenic effects in heart failure with preserved ejection fraction
Deng Shuaishuai1,2, Lin Jingyi1,2, Zhao Zhiqiang1,2
1First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Insights
Heart failure with preserved ejection fraction (HFpEF) is complex due to its heterogeneity. Research suggests parallel pathways involving hypertension, obesity, and potential estrogen effects, particularly in women.
Area of Science:
- Cardiology
- Pathophysiology
- Endocrinology
Background:
- Heart failure with preserved ejection fraction (HFpEF) constitutes 40% of heart failure cases.
- Research into HFpEF mechanisms and treatments has been limited by its complex and heterogeneous nature.
- Hypertension and obesity are recognized as key contributors to HFpEF development.
Purpose of the Study:
- To review the parallel pathophysiological processes underlying HFpEF.
- To explore the epidemiological data highlighting gender differences in HFpEF prevalence.
- To investigate the potential role of estrogen in HFpEF pathogenesis.
Main Methods:
- Literature review of clinical studies on HFpEF.
- Analysis of epidemiological data concerning HFpEF prevalence across demographics.
- Examination of research on sex differences and hormonal influences in cardiovascular disease.
Main Results:
- HFpEF is characterized by potentially parallel, interwoven pathological pathways.
- Prevalence of HFpEF is higher in women than men, especially in older age groups.
- These findings suggest a significant role for sex hormones, like estrogen, in HFpEF.
Conclusions:
- Understanding the heterogeneity and parallel pathways of HFpEF is crucial for advancing treatment.
- Sex differences, particularly the influence of estrogen, warrant further investigation in HFpEF.
- Targeting estrogen pathways may offer novel therapeutic strategies for HFpEF.
Abstract:
Heart failure with preserved ejection fraction (HFpEF) is an essential subtype of heart failure accounting for 40% of the total. However, the related pathological mechanism and drug therapy research have been stagnant for a long time. The direct cause of this dilemma is the heterogeneity of HFpEF. And some researchers believe that there is no common pathway to reach the origin of HFpEF; others argue that there is an unidentified unified pathophysiological process hidden beneath the ice surface. Aside from the debate, a series of clinical studies have shown that hypertension and obesity play a fundamental role in the pathogenesis of HFpEF. These results imply that there may be two parallel pathological processes interweaved in one disease, manifested as multiple coexistent pathological phenomena, like a shadow. Meanwhile, the prevalence of HFpEF in women is higher than in men in any given age group, especially prominent in elderly patients. These pathological processes and epidemiological data reflect gender differences, reminding us to shift our attention to estrogen. This article will review the parallel pathogenesis of HFpEF, and also introduce sex differences and the potential effect of estrogen in this condition below.
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