Sex Difference in Pathophysiology of Heart Failure

초록

Heart failure (HF) remains a significant cause of morbidity and mortality in both men and women; nevertheless, disparities in the etiology, progression, and management of HF between genders have not been extensively explored. Sex-specific variations in traditional risk factors and those related to sex uniquely influence HF incidence and symptomatology. The pathophysiology of HF differs between men and women, which can account for sex-based distinctions in clinical presentation and diagnosis. This, in turn, contributes to variations in responses to pharmacological and device/surgical therapies. Current research indicates that women with HF exhibit greater left ventricular stiffness and higher ejection fractions than men. Increased myocardial fibrosis with aging may explain heightened cardiac rigidity in women. In young women, estrogen may decrease collagen production in cardiac fibroblasts, whereas in men, it stimulates it. Lipid and energy metabolism are better preserved in stressed female hearts compared to males. Mean arterial pressure is a determining factor in HF outcomes for women but not for men. Takotsubo and peripartum cardiomyopathies are rare conditions primarily or exclusively affecting women. Sudden cardiac arrest more frequently affects men; however, women receive less adequate treatment. Further research into sex-based differences in the pathophysiology and treatment of HF is essential. In this section, we explore the unique physiological mechanisms and contributing factors that may differ between men and women, emphasizing the importance of tailored approaches to diagnosis and treatment to optimize HF management for both genders."