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心力衰竭中的性别差异:我们了解什么?

Sex Differences in Heart Failure: What Do We Know?

作者信息

Arata Allegra, Ricci Fabrizio, Khanji Mohammed Y, Mantini Cesare, Angeli Francesco, Aquilani Roberta, Di Baldassarre Angela, Renda Giulia, Mattioli Anna Vittoria, Nodari Savina, Gallina Sabina

机构信息

Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy.

William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK.

出版信息

J Cardiovasc Dev Dis. 2023 Jun 29;10(7):277. doi: 10.3390/jcdd10070277.

Abstract

Heart failure (HF) remains an important global health issue, substantially contributing to morbidity and mortality. According to epidemiological studies, men and women face nearly equivalent lifetime risks for HF. However, their experiences diverge significantly when it comes to HF subtypes: men tend to develop HF with reduced ejection fraction more frequently, whereas women are predominantly affected by HF with preserved ejection fraction. This divergence underlines the presence of numerous sex-based disparities across various facets of HF, encompassing aspects such as risk factors, clinical presentation, underlying pathophysiology, and response to therapy. Despite these apparent discrepancies, our understanding of them is far from complete, with key knowledge gaps still existing. Current guidelines from various professional societies acknowledge the existence of sex-based differences in HF management, yet they are lacking in providing explicit, actionable recommendations tailored to these differences. In this comprehensive review, we delve deeper into these sex-specific differences within the context of HF, critically examining associated definitions, risk factors, and therapeutic strategies. We provide a specific emphasis on aspects exclusive to women, such as the impact of pregnancy-induced hypertension and premature menopause, as these unique factors warrant greater attention in the broader HF discussion. Additionally, we aim to clarify ongoing controversies and knowledge gaps pertaining to the pharmacological treatment of HF and the sex-specific indications for cardiac implantable electronic devices. By shining a light on these issues, we hope to stimulate a more nuanced understanding and promote the development of more sex-responsive approaches in HF management.

摘要

心力衰竭(HF)仍然是一个重要的全球健康问题,对发病率和死亡率有重大影响。根据流行病学研究,男性和女性面临的心力衰竭终生风险几乎相当。然而,在心力衰竭亚型方面,他们的经历存在显著差异:男性更常发生射血分数降低的心力衰竭,而女性主要受射血分数保留的心力衰竭影响。这种差异突显了心力衰竭各个方面存在众多基于性别的差异,包括风险因素、临床表现、潜在病理生理学以及对治疗的反应等方面。尽管存在这些明显差异,但我们对它们的理解还远未完整,关键知识空白仍然存在。各专业协会的现行指南承认心力衰竭管理中存在基于性别的差异,但缺乏针对这些差异提供明确、可操作的建议。在这篇全面综述中,我们在心力衰竭的背景下更深入地探讨这些性别特异性差异,批判性地审视相关定义、风险因素和治疗策略。我们特别强调女性特有的方面,如妊娠高血压和过早绝经的影响,因为这些独特因素在更广泛的心力衰竭讨论中值得更多关注。此外,我们旨在澄清与心力衰竭药物治疗以及心脏植入式电子设备的性别特异性适应症相关的持续争议和知识空白。通过阐明这些问题,我们希望促进更细致入微的理解,并推动在心力衰竭管理中制定更具性别针对性的方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/512e/10380698/a58ef83e6fd1/jcdd-10-00277-g001.jpg

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