Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands.
Nat Rev Cardiol. 2024 Jul;21(7):498-516. doi: 10.1038/s41569-024-00996-1. Epub 2024 Mar 8.
Although sex-related differences in the epidemiology, risk factors, clinical characteristics and outcomes of heart failure are well known, investigations in the past decade have shed light on an often overlooked aspect of heart failure: the influence of sex on treatment response. Sex-related differences in anatomy, physiology, pharmacokinetics, pharmacodynamics and psychosocial factors might influence the response to pharmacological agents, device therapy and cardiac rehabilitation in patients with heart failure. In this Review, we discuss the similarities between men and women in their response to heart failure therapies, as well as the sex-related differences in treatment benefits, dose-response relationships, and tolerability and safety of guideline-directed medical therapy, device therapy and cardiac rehabilitation. We provide insights into the unique challenges faced by men and women with heart failure, highlight potential avenues for tailored therapeutic approaches and call for sex-specific evaluation of treatment efficacy and safety in future research.
尽管性别与心力衰竭的流行病学、危险因素、临床特征和结局之间的差异众所周知，但过去十年的研究揭示了心力衰竭一个经常被忽视的方面：性别对治疗反应的影响。性别相关的解剖学、生理学、药代动力学、药效学和社会心理因素差异可能会影响心力衰竭患者对药物治疗、器械治疗和心脏康复的反应。在这篇综述中，我们讨论了男性和女性在心力衰竭治疗反应方面的相似之处，以及性别相关的治疗益处差异、剂量反应关系以及指南指导的医学治疗、器械治疗和心脏康复的耐受性和安全性。我们深入探讨了心力衰竭男性和女性所面临的独特挑战，强调了针对特定性别治疗方法的潜在途径，并呼吁在未来的研究中对治疗效果和安全性进行性别特异性评估。
