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Sex-related differences in patients' responses to heart failure therapy

Nature Reviews Cardiology volume 9, pages 234–242 (2012)Cite this article

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Abstract

Men and women with heart failure display important differences in clinical characteristics that might affect their responses to pharmacological and nonpharmacological therapies. In women, heart failure is associated with a higher frequency of hypertension, nonischemic cardiomyopathy and left bundle branch block than in men. Subgroup analyses of data from randomized clinical trials suggest that these differences result in a differential response to heart failure therapies, including a somewhat better response to β-blockers, a worse prognosis with digoxin therapy, and a lower survival benefit with implantable cardioverter-defibrillators in women. Importantly, female patients with heart failure also derive significantly greater improvements in cardiac volumes from cardiac resynchronization therapy than do male patients, and this treatment is associated with reduced risks of all-cause mortality and heart failure events among women with mild symptoms. These data suggest that sex-related differences might exist in response to both medical and device therapies for patients with heart failure.

Key Points

  • Women with heart failure demonstrate important differences in clinical characteristics compared with men, including a higher frequency of hypertension, nonischemic etiologies of cardiomyopathy, and left bundle branch block

  • Sex-related differences in clinical characteristics could result in differential responses to medical and device therapies; however, current data are limited to retrospective subgroup analyses in small numbers of women

  • Women with heart failure respond better to β-blockers, but have a worse prognosis with digoxin, than men; angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers are equally effective in both sexes

  • Implantable cardioverter-defibrillator therapy might be associated with a lower survival benefit in women than in men with heart failure

  • Women demonstrate a significantly more favorable echocardiographic response to cardiac resynchronization therapy than men, regardless of their heart failure functional class

  • In women with mild heart failure, cardiac resynchronization therapy results in pronounced reductions in all-cause mortality and heart failure events that are significantly greater than the corresponding reductions in men

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Figure 1: Kaplan–Meier cumulative probability of death or heart failure events differ markedly between men and women.

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Acknowledgements

A. Barsheshet's research is partly supported by funding from the Mirowski–Moss Career Development Award. I. Goldenberg's research is partly supported by the Mirowski Family Foundation.

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  1. Cardiology Division, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, 14642, NY, USA

    Alon Barsheshet, Andrew Brenyo, Ilan Goldenberg & Arthur J. Moss

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Contributions

All four authors researched the data for the article and provided substantial contributions to discussions of its content. A. Barsheshet and A. Brenyo wrote the initial draft of the article, and I. Goldenberg and A. J. Moss developed the initial outline and revised the manuscript before submission.

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Correspondence to Arthur J. Moss.

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Competing interests

A. J. Moss declares that he has received grant or research support from Boston Scientific. The other authors declare no competing interests.

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Barsheshet, A., Brenyo, A., Goldenberg, I. et al. Sex-related differences in patients' responses to heart failure therapy. Nat Rev Cardiol 9, 234–242 (2012). https://doi.org/10.1038/nrcardio.2012.10

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