Sex/Gender Differences in Heart Failure

Sex/gender differences exist in the clinical presentation, prognosis, underlying causes, risk factors, pathophysiology, and treatment response of heart failure. Women with heart failure are more likely to have preserved ejection fraction and experience microvascular dysfunction, while men are more likely to have reduced ejection fraction and coronary artery disease. Women tend to have smaller left ventricular dimensions and lower stroke volumes, necessitating a higher heart rate to maintain cardiac output. Exercise tends to intensify myocardial stiffness in women, resulting in chronotropic incompetence and aggravated symptoms if present. Conversely, estrogen may safeguard mitochondrial functionality and energy metabolism, potentially diminishing heart failure sensitivity in women. Nevertheless, women’s participation in clinical trials assessing drug and medical device efficacy and safety has been relatively limited, potentially leading to inadequate management. Furthermore, the recommended target dosage of medications based on clinical trials may not be appropriate for women, highlighting the need for sex/gender-specific treatment guidelines. More research is needed to better understand the sex/gender differences in heart failure pathophysiology and treatment response.