Females have a higher risk of developing HFpEF but a lower risk of mortality and hospitalization compared to males, driven by different profiles of comorbidities, hormones, and microvascular dysfunction.
What are the sex-specific differences in the pathophysiology, clinical presentation, and prognosis of heart failure with preserved ejection fraction (HFpEF)?
This review highlights the necessity for creating sex-specific risk stratification scales and treatment plans in HFpEF due to distinct pathophysiological and prognostic differences between males and females.
Heart failure is a complex clinical syndrome with many etiological factors and complex pathophysiology affecting millions worldwide. Males and females can have distinct clinical presentation and prognosis, and there is an emerging understanding of the factors that highlight the similarities and differences to synthesize and present available data for sex-specific differences in heart failure with preserved ejection fraction (HFpEF). While the majority of data demonstrate more similarities than differences between females and males in terms of heart failure, there are key differences. Data showed that females have a higher risk of developing HFpEF, but a lower risk of mortality and hospitalization. This can be conditioned by different profiles of comorbidities, postmenopausal changes in sex hormone levels, higher levels of inflammation and chronic microvascular dysfunction in females. These factors, combined with different left ventricular dimensions and function, which are more pronounced with age, lead to a higher prevalence of LV diastolic dysfunction at rest and exercise. As a result, females have lower exercise capacity and quality of life when compared to males. Females also have different activities of systems responsible for drug transformation, leading to different efficacy of drugs as well as higher risk of adverse drug reactions. These data prove the necessity for creating sex-specific risk stratification scales and treatment plans.
Smereka et al. (Wed,) conducted a review in Heart failure with preserved ejection fraction (HFpEF). Females have a higher risk of developing HFpEF but a lower risk of mortality and hospitalization compared to males, driven by different profiles of comorbidities, hormones, and microvascular dysfunction.