Lee Soo Yong, Park Seong-Mi
Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
Division of Cardiology, Anam Hospital, Korea University College of Medicine, Seoul, Korea.
Korean J Intern Med. 2025 Mar;40(2):196-207. doi: 10.3904/kjim.2024.338. Epub 2025 Mar 1.
There are sex-related differences in the pathophysiology and phenotype of heart failure (HF) as well as the pharmacokinetics and pharmacodynamics of drugs between women and men due to biological differences, such as heart and vessel size, response to blood volume and pressure, body water and muscle compositions, and dominant sex hormones. Therefore, target drug doses required to achieve the same clinical effect differ between the sexes, while there may also be sex-related differences in side effects of a given drug at the same dose. These biological differences have been reflected in the results of clinical trials. Moreover, women have been underrepresented in pharmacological therapy trials as well as having lower device implantation rates than men. Therefore, the currently recommended target doses of medications based on clinical trials may not be appropriate for women. Although guidelines for HF have been standardized since the last major revision in 2021, most do not differentiate by sex. This review focuses on evidence regarding sex-related differences in multiple aspects of HF, including epidemiology, pathophysiology, clinical features, treatment, and prognosis, highlighting the need for sex-specific treatment guidelines.
由于心脏和血管大小、对血容量和压力的反应、身体水分和肌肉组成以及主要性激素等生物学差异，心力衰竭（HF）的病理生理学和表型以及男女之间药物的药代动力学和药效学存在性别差异。因此，实现相同临床效果所需的目标药物剂量在性别之间有所不同，而在相同剂量下，给定药物的副作用也可能存在性别差异。这些生物学差异已在临床试验结果中得到体现。此外，女性在药物治疗试验中的代表性不足，且器械植入率低于男性。因此，目前基于临床试验推荐的药物目标剂量可能不适用于女性。尽管自2021年上次重大修订以来，HF指南已实现标准化，但大多数指南并未按性别进行区分。本综述重点关注HF多个方面性别差异的证据，包括流行病学、病理生理学、临床特征、治疗和预后，强调需要制定针对性别的治疗指南。
