Scuola Superiore Sant'Anna, Pisa, Italy; University of Pisa, Italy.
Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
Int J Cardiol. 2018 Mar 15;255:145-151. doi: 10.1016/j.ijcard.2017.10.068.
The prevalence of chronic heart failure (CHF) is steadily increasing. Both sexes are affected, with significant differences in etiology, epidemiology and clinical presentation, prognosis, comorbidities, and response to treatment. Women tend to develop CHF at a more advanced age, present more often with HF with preserved ejection fraction, are more symptomatic, and have a worse quality of life than men, but also a better prognosis. In women, CHF has more frequently a non-ischemic etiology, and arterial hypertension and diabetes mellitus are leading comorbidities. Furthermore, many sex-related differences have been detected in the response to treatment, for example a greater prognostic benefit from angiotensin-receptor blockers in women, a higher incidence of complications after defibrillator implantation, and a greater response to cardiac resynchronization therapy. Furthermore, women are less likely to receive defibrillator therapy or heart transplantation. The significant underrepresentation of women in clinical trials limits our capacity to evaluate the extent of sex-related differences in CHF, although their characterization seems crucial in order to achieve the ultimate goal of a tailored therapy for this condition.
慢性心力衰竭（CHF）的患病率正在稳步上升。男女均可发病，其病因、流行病学和临床表现、预后、合并症以及对治疗的反应均存在显著差异。女性发生 CHF 的年龄更大，更常出现射血分数保留型心力衰竭，症状更明显，生活质量较男性差，但预后更好。在女性中，CHF 更常由非缺血性病因引起，动脉高血压和糖尿病是主要的合并症。此外，在治疗反应方面也检测到许多与性别相关的差异，例如女性使用血管紧张素受体阻滞剂的预后获益更大，植入除颤器后并发症的发生率更高，以及对心脏再同步治疗的反应更大。此外，女性接受除颤器治疗或心脏移植的可能性较低。临床试验中女性代表性不足限制了我们评估 CHF 中与性别相关差异的程度，尽管对其进行特征描述似乎至关重要，以实现针对这种情况的个体化治疗的最终目标。
