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STATE-OF-THE-ART PAPER

Heart Failure in Women

A Need for Prospective Data

Eileen M. Hsich, MD^_*,,_* and Ileana L. Piña, MD

^_* Department of Cardiovascular Medicine at the Cleveland Clinic, Cleveland, Ohio
Case Western Reserve University/Louis Stokes VA Medical Center, Cleveland, Ohio

Manuscript received September 10, 2008; revised manuscript received February 5, 2009, accepted February 9, 2009.

^_* Reprint requests and correspondence: Dr. Eileen M. Hsich, Kaufman Center for Heart Failure, Department of Cardiovascular Medicine, Cleveland Clinic, F-25, 9500 Euclid Avenue, Cleveland, Ohio 44195 (Email: Hsiche{at}ccf.org).

Heart failure affects 5 million Americans, and nearly 50% of these are women. Sex differences have been noted regarding the underlying etiology, pathophysiology, and prognosis. Women are less likely to have coronary artery disease and more likely than men to have hypertension and valvular disease as the underlying etiology. They often present at an older age with better systolic function than men. For both sexes, there is significant morbidity, but age-adjusted data reveal that women have a better survival. Despite these known sex differences, medical management recommendations are the same for women and men, because prospective sex-specific clinical trials have not been performed. However, our review raises some concerns that women might respond differently to therapy.

Key Words: heart failure • sex • women

Abbreviations and Acronyms   ACEI = angiotensin-converting enzyme inhibitor   ARB = angiotensin receptor blocker   CAD = coronary artery disease   CI = confidence interval   CVD = cardiovascular disease   HF = heart failure   HR = hazard ratio   ICD = implantable cardioverter-defibrillator   LV = left ventricular   LVEF = left ventricular ejection fraction   NIH = National Institutes of Health   NYHA = New York Heart Association   PPCM = peripartum cardiomyopathy   RR = relative risk

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J. Am. Coll. Cardiol. 2009 54: A13-A16. [Full Text] [PDF]