Department of Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.
J Geriatr Cardiol. 2011 Mar;8(1):15-23. doi: 10.3724/SP.J.1263.2011.00015.
Heart failure (HF) is an increasing problem for the aging population, specifically among women. The etiology of HF influences both the selection and outcome of the treatment. There are variations between genders in morbidity and mortality in different studies, possibly reflecting etiology. The objective of this study was to examine the strength of evidence available for gender differences in the etiology of chronic heart failure.
Computer-assisted searches from 1980-2009 for gender differences in the etiology of heart failure were performed (Medline, EMBASE and PubMed). From 2347 abstracts reviewed based on inclusion criteria, 35 original articles were chosen for review. Data extraction was based on observational studies (prospective/retrospective cohort or cross sectional) with a mean follow up of 3 months. There was no interrater variability between the 2 reviewers on data-extraction.
Ventricular systolic dysfunction being more associated with male sex, but female sex was more reported to be associated with preserved left ventricular function. Ischemic etiology and associated coronary heart disease were strongly correlated with male sex. The risk for HF was dramatically more elevated for women with systolic hypertension but the association for diabetes mellitus as the etiology of HF was somewhat equal between males and females.
One of the limitations in reaching conclusions about gender differences in cardiovascular disease is that many major clinical trials do not include a gender analysis nor they are powered to do so as women are under-represented in most of the HF studies. The need remains for a well designed prospective study of sufficient numbers of male and female patients with and without heart failure and analyzing etiology and risk factors based on the sex differences.
心力衰竭（HF）是老龄化人口，尤其是女性面临的日益严重的问题。HF 的病因会影响治疗的选择和结果。不同研究中男女在发病率和死亡率方面存在差异，这可能反映了病因的差异。本研究旨在检查现有关于慢性心力衰竭病因中性别差异的证据强度。
从 1980 年至 2009 年，使用计算机辅助搜索（Medline、EMBASE 和 PubMed）查找心力衰竭病因中性别差异的相关文献。根据纳入标准，从 2347 篇摘要中筛选出 35 篇原始文章进行综述。数据提取基于观察性研究（前瞻性/回顾性队列或横断面研究），平均随访时间为 3 个月。两名审阅者之间在数据提取方面没有组内变异。
心室收缩功能障碍与男性更相关，但女性更易发生左心室功能保留。缺血性病因和相关的冠心病与男性密切相关。女性收缩期高血压发生心力衰竭的风险显著升高，但糖尿病作为心力衰竭病因的相关性在男性和女性之间大致相等。
得出关于心血管疾病中性别差异的结论存在的一个局限性是，许多主要的临床试验都没有进行性别分析，也没有能力进行性别分析，因为女性在大多数心力衰竭研究中的代表性不足。需要设计一项基于性别差异的、有足够数量的男性和女性心力衰竭患者和非心力衰竭患者的前瞻性研究，分析病因和危险因素。
