Heart Failure in Women: Epidemiology, Biology and Treatment
Heart Failure in Women: Epidemiology, Biology and Treatment
Although women account for a significant proportion of the growing heart failure epidemic, they have been poorly represented in clinical trials. As emerging epidemiologic data reveal a growing prevalence and burden of disease among women, it is increasingly important that treating physicians and researchers recognize sex-based differences. Despite the overall incidence of heart failure being lower in women compared with men, the magnitude of improvement in survival over the last several decades has been less apparent in women. Women with heart failure are more likely to be older, have preserved systolic function and nonischemic cardiomyopathy. While clinical trials have demonstrated improved outcomes among heart failure patients, they have predominantly included men, yielding results that are sometimes inadequately powered to detect a benefit for women. Without adequate representation of women in clinical trials, one cannot assume that the same level of therapeutic evidence also applies to women. Nonetheless, it appears that -blockers and angiotensin-converting enzyme inhibitors provide the same survival benefits in women with systolic dysfunction as in men. In addition, some studies suggest that angiotensin-receptor blockers may lead to a better survival in women when compared with angiotensin-converting enzyme inhibitors. Focused research is needed to understand and guide the management of women with heart failure.
Heart failure prevalence has been increasing steadily over the last decades, fueled in large part by an aging population and advancements in the treatment of coronary heart disease. Over 5 million people currently have heart failure in the USA, with an equal number in Western Europe, and over 500,000 new cases are being diagnosed yearly on each side of the Atlantic ocean. Although women make up more than half of this heart failure population and account for the majority of the hospital admissions, they remain under-represented in clinical trials. Recent data suggest that biological variability in response to risk factors may account for the differences in epidemiology, clinical characteristics and treatment response in women compared with their male counterparts. The present review will highlight some of these differences.
Abstract and Introduction
Abstract
Although women account for a significant proportion of the growing heart failure epidemic, they have been poorly represented in clinical trials. As emerging epidemiologic data reveal a growing prevalence and burden of disease among women, it is increasingly important that treating physicians and researchers recognize sex-based differences. Despite the overall incidence of heart failure being lower in women compared with men, the magnitude of improvement in survival over the last several decades has been less apparent in women. Women with heart failure are more likely to be older, have preserved systolic function and nonischemic cardiomyopathy. While clinical trials have demonstrated improved outcomes among heart failure patients, they have predominantly included men, yielding results that are sometimes inadequately powered to detect a benefit for women. Without adequate representation of women in clinical trials, one cannot assume that the same level of therapeutic evidence also applies to women. Nonetheless, it appears that -blockers and angiotensin-converting enzyme inhibitors provide the same survival benefits in women with systolic dysfunction as in men. In addition, some studies suggest that angiotensin-receptor blockers may lead to a better survival in women when compared with angiotensin-converting enzyme inhibitors. Focused research is needed to understand and guide the management of women with heart failure.
Introduction
Heart failure prevalence has been increasing steadily over the last decades, fueled in large part by an aging population and advancements in the treatment of coronary heart disease. Over 5 million people currently have heart failure in the USA, with an equal number in Western Europe, and over 500,000 new cases are being diagnosed yearly on each side of the Atlantic ocean. Although women make up more than half of this heart failure population and account for the majority of the hospital admissions, they remain under-represented in clinical trials. Recent data suggest that biological variability in response to risk factors may account for the differences in epidemiology, clinical characteristics and treatment response in women compared with their male counterparts. The present review will highlight some of these differences.
