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Updated: Sep 10, 2025

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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Vascular function in women with heart failure with preserved ejection fraction: a mismatch beyond diastole

Nicholas A Carlini1,2, D Walter Wray1,2,3, Kerrie L Moreau4,5

  • 1Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah, United States.

Journal of Applied Physiology (Bethesda, Md. : 1985)
|August 21, 2025
PubMed

Insights

Heart failure with preserved ejection fraction (HFpEF) affects men and women differently, particularly in vascular health. Estrogen loss in women may worsen HFpEF outcomes, highlighting sex-specific health implications.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Women's Health

Background:

  • Heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of heart failure cases.
  • HFpEF is more common in women, with distinct clinical presentations and prognoses compared to men.
  • Sex differences in HFpEF may stem from anatomical, physiological, and hormonal variations, including the role of estrogen.

Purpose of the Study:

  • To review current evidence on sex differences in vascular function within HFpEF.
  • To explore the impact of estrogen loss on female HFpEF physiology.
  • To identify potential future research directions for women's health in HFpEF.

Main Methods:

  • Mini-review of recent scientific literature.
  • Focus on coronary microvascular function, peripheral vascular function, and central arterial stiffness.
  • Examination of hormonal mechanisms, particularly estrogen's role.

Main Results:

  • Significant sex-based disparities exist in vascular health among HFpEF patients.
  • Estrogen deficiency in women may negatively impact vascular parameters.
  • Age-related hormonal changes contribute to distinct HFpEF phenotypes in women.

Conclusions:

  • Sex differences, especially hormonal ones, are critical in understanding HFpEF.
  • Estrogen's role warrants further investigation for targeted women's health interventions.
  • Addressing sex-specific mechanisms is crucial for improving HFpEF management.

Keywords:
HFpEFarterial stiffnessbiological sexendotheliumestrogen

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