Key result
Women face double the lifetime risk of HFpEF vs. HFrEF alongside distinct sex-specific mechanisms.
Why the study?
Gender-specific diagnostic parameters and treatment options for HFpEF have been hindered by low participation of women in cardiovascular trials, despite women having double the lifetime risk of developing HFpEF compared with HFrEF.
This review highlights that women have a disproportionately higher lifetime risk of HFpEF and distinct pathophysiological mechanisms, emphasizing the need for sex-specific diagnostic criteria and greater inclusion in clinical trials.
Supports sex-specific HFpEF evaluation in women; leaves open optimal therapies without dedicated trials.
PURPOSE OF REVIEW: This review highlights differences in pathophysiologic mechanisms, diagnostic challenges and therapeutic responses of heart failure with preserved ejection fraction (HFpEF) in women. RECENT FINDINGS: Emerging research provides further insight into the pathophysiology of HFpEF in women, and the role of obesity and its impact on treatment. Other theories highlight the role of microvascular dysfunction in women with HFpEF. Gender differences in cardiac imaging parameters for assessment of diastolic dysfunction and elevated filling pressures may require refinement for improved diagnostic accuracy of HFpEF in women. HFpEF is fast becoming the dominant form of heart failure in the US and women have double the lifetime risk of developing HFpEF compared with heart failure with reduced ejection fraction. Gender-specific diagnostic parameters and treatment options have been hindered by low participation of women in cardiovascular trials. Increased participation in larger scale trials and further investigations into sex-specific pathophysiology are needed for improved outcomes in women.
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Andrade‐Bucknor et al. (2026) conducted a review in Heart failure with preserved ejection fraction (HFpEF). Women have double the lifetime risk of developing HFpEF compared with HFrEF, and exhibit unique sex-specific pathophysiological mechanisms, diagnostic challenges, and therapeutic responses.
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