Sex differences in vascular function among individuals with heart failure: a systematic review

Area of Science:

• Cardiovascular Medicine
• Vascular Physiology
• Sex Differences in Health

Background:

• Heart failure with preserved ejection fraction (HFpEF) is more common in women, while heart failure with reduced ejection fraction (HFrEF) is more prevalent in men.
• Sex-specific differences in vascular function within heart failure (HF) populations are not well understood.
• Existing research indicates epidemiological disparities in HF subtypes between sexes.

Purpose of the Study:

• To systematically review and evaluate sex-related differences in vascular function among individuals diagnosed with heart failure.
• To synthesize findings on arterial stiffness and compliance stratified by sex in HF patients.
• To investigate the influence of body mass index (BMI) on observed sex differences in vascular function.

Main Methods:

• A systematic literature review using a narrative synthesis approach.
• Searches conducted in MEDLINE and CINAHL databases from inception to November 26, 2024.
• Inclusion of nine studies (n=2820) reporting sex-stratified arterial stiffness measures in HF patients, with 78% focusing on HFpEF.

Main Results:

• Women with HF exhibited significantly higher pulsatile arterial load and lower arterial compliance compared to men.
• Specific findings include higher augmentation index and augmentation pressure in women.
• Sex differences persisted even after adjusting for body mass index (BMI).

Conclusions:

• Women with heart failure experience greater pulsatile arterial load and reduced arterial compliance than men.
• These sex-specific vascular alterations contribute to HF pathophysiology.
• The findings underscore the importance of sex-informed cardiovascular assessments in heart failure management.