Heart failure in women is different than in men; should treatment be different

Women with heart failure differ from their male counterparts in a number of ways, including etiology, pattern of cardiac remodeling, and prognosis.

They may even respond differently to medical therapy. But until prospective, sex-specific studies show that we should do otherwise, we recommend that women with heart failure be treated the same as men, according to established guidelines.

Women tend to develop heart failure at an older age and with better left ventricular systolic function compared with men.

Women are more likely than men to have hypertension and diabetes as underlying risk factors for heart failure and are less likely to have coronary artery disease.

However, when they have coronary artery disease, it is a strong risk factor for the development of heart failure.

The morbidity associated with heart failure in women is significant, but the prognosis is better than in men, since women with heart failure generally survive longer.

Current guidelines for heart failure therapy are not sexspecific, since there are no large, prospective, randomized, blinded, sex-specific heart failure therapeutic trials.

RiGHT NOW, WE KNOW more about how heart failure is different in women than whether it should be treated differently.

Studies of heart failure treatment have included mostly men, and the results have been generalized to women even though there are pharmacologic and pathophysiologic differences between the sexes. In fact, most of our current knowledge about treating heart failure in women is based on post hoc analyses.

Until prospective sex-specific studies are performed, however, we recommend following current guidelines and treating women with heart failure the same as we treat men.

WOMEN DEVELOP HEART FAILURE LATER

Heart failure affects nearly 5 million people in the United States, and more than 50% of them are women. Compared with men, women tend to develop heart failure at an older age1 and with better left ventricular systolic function. Heart failure with preserved left ventricular function is also more common in women.

RISK FACTORS ARE SIMILAR, BUT RELATIVE RISKS ARE DIFFERENT

The risk factors for heart failure are similar in women and men, but the relative risks are different.

Below is a discussion of the risk factors for heart failure from the perspective of women, and a brief discussion of peripartum cardiomyopathy.

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Cleveland Clinic Journal of Medicine, 06/05/07