The Kolling Institute, University of Sydney, Sydney, NSW, Australia.
Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.
Curr Heart Fail Rep. 2021 Dec;18(6):345-352. doi: 10.1007/s11897-021-00533-y. Epub 2021 Nov 15.
There is an increasing recognition of the importance of sex in susceptibility, clinical presentation, and outcomes for heart failure. This review focusses on heart failure with reduced ejection fraction (HFrEF), unravelling differences in biology, clinical and demographic features and evidence for diagnostic and therapeutic strategies. This is intended to inform clinicians and researchers regarding state-of-the-art evidence relevant to women, as well as areas of unmet need.
Females are well recognised to be under-represented in clinical trials, but there have been some improvements in recent years. Data from the last 5 years reaffirms that women presenting with HFrEF women are older and have more comorbidities like hypertension, diabetes and obesity compared with men and are less likely to have ischaemic heart disease. Non-ischaemic aetiologies are more likely to be the cause of HFrEF in women, and women are more often symptomatic. Whilst mortality is less than in their male counterparts, HFrEF is associated with a bigger impact on quality of life in females. The implications of this for improved prevention, treatment and outcomes are discussed. This review reveals distinct sex differences in HFrEF pathophysiology, types of presentation, morbidity and mortality. In light of this, in order for future research and clinical medicine to be able to manage HFrEF adequately, there must be more representation of women in clinical trials as well as collaboration for the development of sex-specific management guidelines. Future research might also elucidate the biochemical foundation of the sex discrepancy in HFrEF.
越来越多的人认识到性别在心力衰竭易感性、临床表现和结局中的重要性。本综述重点关注射血分数降低的心力衰竭（HFrEF），阐述生物学、临床和人口统计学特征方面的差异，以及诊断和治疗策略的证据。其目的是向临床医生和研究人员提供与女性相关的最新循证医学证据，以及未满足的需求领域。
女性在临床试验中的代表性严重不足，这一现象已得到充分认识，但近年来有所改善。过去 5 年的数据再次证实，与男性相比，女性 HFrEF 患者年龄更大，合并症更多，如高血压、糖尿病和肥胖症，且更有可能患有缺血性心脏病。非缺血性病因更有可能导致女性发生 HFrEF，且女性的症状更为常见。尽管女性的死亡率低于男性，但 HFrEF 对女性生活质量的影响更大。讨论了这对改善预防、治疗和结局的意义。本综述揭示了 HFrEF 病理生理学、表现类型、发病率和死亡率方面的明显性别差异。鉴此，为了使未来的研究和临床医学能够充分管理 HFrEF，必须在临床试验中增加女性的代表性，并合作制定针对特定性别的管理指南。未来的研究也可能阐明 HFrEF 中性别差异的生化基础。
