Sex-based differences in risk determinants and management of heart failure

In the United States, more than 40% of heart failure (HF) patients are women, and among the elderly the prevalence of HF is greater in women than in men. Generally, HF affects women at a more advanced age with better global left ventricular systolic function, compared with men. The risk factors associated with HF and its underlying pathophysiology partially differ by sex. Hypertension and diabetes mellitus impose a greater risk of HF in women than in men, who are more likely to have coronary artery disease as an etiology. Most large HF trials have under-represented women in their enrollment numbers, and this has narrowed our understanding of sex-related differences in HF pathophysiology, diagnosis, and treatment. Among patients with HF, survival seems to be better in women than men, with the likely exception of patients with HF due to ischemic heart disease where prognosis is similar in both sexes. Current treatment guidelines are not sex-specific because sufficient data is not available, however, as the therapeutic options for HF expand, sex-based modifications to HF management may be considered in future revisions.