Postigo Andrea, Martínez-Sellés Manuel
Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Front Cardiovasc Med. 2020 Dec 21;7:616273. doi: 10.3389/fcvm.2020.616273. eCollection 2020.
Heart failure (HF) affects 1-2% of the population in developed countries and ~50% of patients living with it are women. Compared to men, women are more likely to be older and suffer hypertension, valvular heart disease, and non-ischemic cardiomyopathy. Since the number of women included in prospective HF studies has been low, much information regarding HF in women has been inferred from clinical trials observations in men and data obtained from registries. Several relevant sex-related differences in HF patients have been described, including biological mechanisms, age, etiology, precipitating factors, comorbidities, left ventricular ejection fraction, treatment effects, and prognosis. Women have greater clinical severity of HF, with more symptoms and worse functional class. However, females with HF have better prognosis compared to males. This survival advantage is particularly impressive given that women are less likely to receive guideline-proven therapies for HF than men. The reasons for this better prognosis are unknown but prior pregnancies may play a role. In this review article we aim to describe sex-related differences in HF and how these differences might explain why women with HF can expect to survive longer than men.
心力衰竭（HF）在发达国家影响着1%-2%的人口，其中约50%的患者为女性。与男性相比，女性年龄更大，更易患高血压、心脏瓣膜病和非缺血性心肌病。由于纳入前瞻性心力衰竭研究的女性数量较少，许多关于女性心力衰竭的信息是从对男性的临床试验观察以及登记处获得的数据中推断出来的。心力衰竭患者中存在一些与性别相关的差异，包括生物学机制、年龄、病因、诱发因素、合并症、左心室射血分数、治疗效果和预后。女性心力衰竭的临床严重程度更高，症状更多，心功能分级更差。然而，与男性相比，女性心力衰竭患者的预后更好。考虑到女性接受心力衰竭指南推荐治疗的可能性低于男性，这种生存优势尤其令人印象深刻。这种较好预后的原因尚不清楚，但既往妊娠可能起到了一定作用。在这篇综述文章中，我们旨在描述心力衰竭中与性别相关的差异，以及这些差异如何解释为什么女性心力衰竭患者预期寿命比男性更长。
