Open Access Peer-reviewed

Heart Failure in Women: A Disease with Peculiar Pathophysiological Mechanisms and Clinical Presentation

Giulia D'Agostini1,, Mariantonietta Cicoira1, Corrado Vassanelli1

1Section of Cardiology, Dept. of Medicine, University of Verona, Verona, Italy

American Journal of Cardiovascular Disease Research. 2013, 1(1), 1-6. DOI: 10.12691/ajcdr-1-1-1
Published online: August 25, 2017

Abstract

Heart Failure (HF) is a disease whose prevalence is increasing in developed countries, involving up to 10% of the older population; the increase is due both to better therapy and to the aging population. Fifty percent (50%) of these patients are women, most of them presenting with preserved systolic function and diastolic dysfunction. Female patients show different etiology to males; they present several comorbidities and at an older age. Despite this, women appear to have a lower mortality risk, and female gender is an independent prognostic factor for better survival. An explanation for this different presentation and prognosis may be different ventricular remodeling in response to pressure burden on the left ventricle, leading to completely different left ventricular geometry and compliance mechanisms. These differences are not only detectable at macroscopic examinations but also appear in microscopic gene and molecular expression, with a reduction in apoptosis during lifetime and a lower myocyte volume. Although all these mechanisms have a protective role in chronic HF, different remodeling in women leads to a weak balance in the acute setting, with an imbalance between compensatory mechanisms and higher cardiac output requirements. This impairment goes along with the loss of female gender advantage after hospitalization. Despite the peculiar presentation of HF in women, there is little evidence about therapy in this setting, due to under-representation of women in clinical trials and the absence of sex-specific, prospective randomized trials.

Keywords:

heart failure, gender
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