Current Cardiology Reports

, Volume 7, Issue 3, pp 159–165

Heart failure in women

  • Denise D. Barnard
Article
  • 45 Downloads

Abstract

Increasingly high mortality from cardiovascular disease in women has sparked nationwide campaigns to raise awareness of this significant threat to women’s health. Heart failure has the most lethal prognosis of the major cardiovascular diseases, yet women demonstrate an apparent survival advantage compared with men. Sex-linked disparities in heart failure risk factors and pathophysiology contribute to this divergent clinical outcome. Heart failure etiology and clinical manifestations unique to female sex exist. At age 40, the lifetime risk of developing heart failure is equal for men and women, whereas the lifetime risk of developing coronary heart disease is one in two for men and one in three for women. Understanding sex-inherent characteristics related to heart failure may help determine whether the optimal therapy for this prevalent syndrome should be modified according to sex. Until prospective trial data prove otherwise, heart failure treatment guidelines should be uniformly applied to both women and men.

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References and Recommended Reading

  1. 1.
    Heart Disease and Stroke Statistics — 2005 Update. American Heart Association. http://www.americanheart.org/presenter. jhtml?identifier=3000090Google Scholar
  2. 2.
    Lloyd-Jones DM, Larson MG, Leip EP, et al.: Lifetime risk for developing congestive heart failure: the Framingham study. Circulation 2002, 106:3068–3072. The Framingham population included equal proportions of men and women with strictly defined criteria for determining HF. The trends reported and the ability to predict lifetime HF risk at various ages represents an enormously important body of work that is relevant to daily patient care.PubMedCrossRefGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention: 2002 National Health Care Statistics. http://www.cdc.gov/nchs/data/hus/ hus02.pdfGoogle Scholar
  4. 4.
    Lund LH, Mancini D: Heart failure in women. Med Clin North Am 2004, 88:321-345.CrossRefGoogle Scholar
  5. 5.
    Petrie MC, Dawson NF, Murdoch DR, et al.: Failure of women’s hearts. Circulation 1999, 99:2334–2341.PubMedGoogle Scholar
  6. 6.
    Levy D, Kenchaiah S, Larson MG, et al.: Long-term trends in the incidence of and survival with heart failure. N Engl J Med 2002, 347:1397–1402.PubMedCrossRefGoogle Scholar
  7. 7.
    Chobanian AV, Bakris GL, Black HR et al.: The Seventh Report of the Joint National Committee on Prevention,Detection, Evaluation and Treatment of High Blood Pressure: the JNC-7 report. JAMA 2003, 289:2560–2573.PubMedCrossRefGoogle Scholar
  8. 8.
    Ho KKL, Pinsky JL, Kannel WB, Levy D: The epidemiology of heart failure: the Framingham study. J Am Coll Cardiol 1993, 22:6A-13A.PubMedCrossRefGoogle Scholar
  9. 9.
    Senni M, Tribouilloy CM, Rodeheffer RJ, et al.: Congestive heart failure in the community: trends in incidence and survival in a 10-year period. Arch Intern Med 1999, 159:29–34. This work validates the application of Framingham HF criteria to other communities, enhancing its relevance direct to clinical practice models.PubMedCrossRefGoogle Scholar
  10. 10.
    Redfield MM, Jacobsen SJ, Burnett JC, et al.: Burden of systolic and diastolic ventricular dysfunction in the community. Appreciating the scope of the heart failure epidemic. JAMA 2003, 289:194–202. This paper defines the relative frequency of systolic and diastolic dysfunction in a large population, and illustrates how common HF with preserved systolic function is. It also confirms that prognosis is affected by ventricular dysfunction regardless of attributable symptoms.PubMedCrossRefGoogle Scholar
  11. 11.
    Hermann DD, Hoppe BL: Gender differences in the causes and natural history of heart failure.Curr Cardiology Rep 2003, 5:193–199.Google Scholar
  12. 12.
    Yusuf S, Pfeffer MA, Svedberg K, et al.: Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 2003, 362:777–781. The only major clinical HF trial evaluating a subset of patients with HF and preserved systolic function. Unlike trials of systolic dysfunction, this cohort included nearly 40% women reflecting known etiologic differences in HF between women and men. Outcome data according to sex are as yet unpublished, but are eagerly anticipated.PubMedCrossRefGoogle Scholar
  13. 13.
    Johnstone D, Limacher M, Rousseau M, et al.: Clinical characteristics of patients in the Studies of Left Ventricular Dysfunction. Am J Cardiol 1992, 70:894–900.PubMedCrossRefGoogle Scholar
  14. 14.
    American Medical Association. Report 4 of the Council on Scientific Affairs. Presented at the 2000 AMA Interim Meeting. Orlando, FL; December 3-6, 2000.Google Scholar
  15. 15.
    Topol E, Traill T, Fortuin N: Hypertensive hypertrophy cardiomyopathy of the elderly. N Engl J Med 1985, 312:277–283.PubMedCrossRefGoogle Scholar
  16. 16.
    Galderisi M, Anderson KM, Wilson PW, Levy D: Echocardiographic evidence for the exsistence of a distinct diabetic cardiomyopathy (bdthe Framingham Heart Study). Am J Cardiol 1991, 68:85–89.PubMedCrossRefGoogle Scholar
  17. 17.
    Kannel WB: Epidemiology aspects of heart failure. Cardiol Clin 1989, 7:1–9.PubMedGoogle Scholar
  18. 18.
    Kimmelstiel C, Goldberg RJ: Congestive heart failure in women: focus on heart failure die to coronary artery disease and diabetes. Cardiology 1990, 77(Suppl 2):71–79.PubMedCrossRefGoogle Scholar
  19. 19.
    Hoffman RM, Pstay BM, Kronal RA: Modifiable risk factors for the incident heart failure in the Coronary Artery Surgery Study. Arch Inter Med 1994, 154:417–423.CrossRefGoogle Scholar
  20. 20.
    Bibbins-Domingo K, Lin F, Vittinghoff E, et al.: Predictors of heart failure among women with coronary disease. Circulation 2004, 100:1424–1430.CrossRefGoogle Scholar
  21. 21.
    Hunt SA, Baker DW, Chin MH, et al.: Evaluation and management of heart failure. ACC/AHA practice guidelines for evaluation and management of chronic heart failure in the adult. J Am Coll Cardiol 2001, 38:2101–2113.PubMedCrossRefGoogle Scholar
  22. 22.
    Burke GL, Bell RA: Global trends in cardiovascular disease: incidence and risk factors. In Preventive Cardiology: A Practical Approach. Edited by Wong ND. New York: McGraw-Hill; 2005:22–42.Google Scholar
  23. 23.
    Philbin EF, DiSalvo TG: Influence of race and gender on care process, resource use, and outcomes in congestive heart failure. Am J Cardiol 1998, 82:76–81.PubMedCrossRefGoogle Scholar
  24. 24.
    Heiat A, Gross CP, Krumholz HM: Representation of the elderly, women and minorities in heart failure clinical trials. Arch Inter Med 2002, 162:1682–1688. This work reviews the limitations of current HF trials related to recruitment of underrepresented populations, providing good insights for future trial design.CrossRefGoogle Scholar
  25. 25.
    Tandon S, Hankins SR, LeJemtel TH: Clinical profile of chronic heart failure in elderly women. Am J Geriatr Cardio 2002, 11:318–323.Google Scholar
  26. 26.
    Vasan RS, Benjamin EJ, Levy D: Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol 1995, 26:1565–1574.PubMedCrossRefGoogle Scholar
  27. 27.
    He J, Ogden LG, Bazzano LA, et al.: Risk factors for congestive heart failure in US men and women. Arch Intern Med 2001, 161:996–1002.PubMedCrossRefGoogle Scholar
  28. 28.
    De Maria R, Gavazzi A, Recalcati F, et al., for the Italian Multicenter Cardiomyopathy Study Group: Comparison of clinical findings in idiopathic dilated cardiomyopathy in women versus men. Am J Cardiol 1993, 72:580–585.PubMedCrossRefGoogle Scholar
  29. 29.
    The SOLVD Investigators: Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991, 325:293–302.CrossRefGoogle Scholar
  30. 30.
    The SOLVD Investigators: Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med 1992, 327:685–691.CrossRefGoogle Scholar
  31. 31.
    Mendes LA, Davidoff R, Cupples LA, et al.: Congestive heart failure in patients with coronary artery disease: the gender paradox. Am Heart J 1997, 134:207–212.PubMedCrossRefGoogle Scholar
  32. 32.
    Carroll JD, Carroll EP, Feldman T: Sex-associated differences in left ventricular function in aortic stenosis of the elderly. Circulation 1992, 86:1099–1107.PubMedGoogle Scholar
  33. 33.
    Crabbe DL, Dipla K, Ambati S, et al.: Gender differences in post-infarction hypertrophy in end-stage failing hearts. J Am Coll Cardiol 2003, 41:300–306.PubMedCrossRefGoogle Scholar
  34. 34.
    Babiker FA, Windt LJ, van Eickels M, et al.: Estrogenic hormone action in the heart: regulatory network and function. Cardiovasc Res 2002, 53:709–719.PubMedCrossRefGoogle Scholar
  35. 35.
    Light KC, Hinderliter AL, West SG, et al.: Hormone replacement improves hemodynamic profile and left ventricular geometry in hypertensive and normotensive post-menopausal patients. J Hypertens 2001, 2:269–278.CrossRefGoogle Scholar
  36. 36.
    Fischer M, Baessler A, Schunkert H: Renin-angiotensin system and gender differences in the cardiovascular system. Cardiovasc Res 2002, 53:672–677.PubMedCrossRefGoogle Scholar
  37. 37.
    Douglas PS, Katz SE, Weinberg EO: Hypertrophic remodeling: gender differences in the early response to left ventricular pressure overload. J Am Coll Cardiol 1998, 32:1118–1125.PubMedCrossRefGoogle Scholar
  38. 38.
    Feldmer M, Kaling M, Takahashi S, et al.: Glucocorticoid and estrogen-responsive elements in the 5' flanking region of the rat angiotensinogen gene. J Hypertens 1991, 9:1005–1012.PubMedCrossRefGoogle Scholar
  39. 39.
    Clauser E, Gaillard I, Wei L, Corvol P: Regulation of angiotensinogen gene. Am J Hypertens 1989, 2:403–410.PubMedGoogle Scholar
  40. 40.
    The CONSENSUS Trial Group: Effect of enalapril on mortality in severe congestive heart failure. N Engl J Med 1987, 316:1429–1435.CrossRefGoogle Scholar
  41. 41.
    The Trandolapril Cardiac Evaluation (TRACE) Group: A clinical trial of the angiotensinogen converting enzyme trandolapril inpatients with left ventricular dysfunction after myocardial infarction. N Engl J Med 1995, 333:1670–1676.CrossRefGoogle Scholar
  42. 42.
    Ambrosioni E, Borghi C, Magnani B: The effect of angiotensin converting enzyme inhibitor zofenopril on mortality and morbidity after anterior myocardial infarction. N Engl J Med 1995, 332:80–85.PubMedCrossRefGoogle Scholar
  43. 43.
    The SAVE Investigators: Effect of mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the Survival and Ventricular Enlargement (SAVE) trial. N Engl J Med 1992, 327:669–677.CrossRefGoogle Scholar
  44. 44.
    Garg R, Yusuf S: Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. JAMA 1995, 273:1450–1456.PubMedCrossRefGoogle Scholar
  45. 45.
    Packer M, Bristow MR, Cohn JN, et al.: The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 1996, 334:1349–1355.PubMedCrossRefGoogle Scholar
  46. 46.
    Ghali JK, Pina IL, Gottlieb SS, et al., for the MERIT-HF Study Group: Metoprolol CR/XL in female patients with heart failure. Analysis of the experiences in Metoprolol Extendedrelease Randomization Intervention Trial in Heart Failure (MERIT-HF). Circulation 2002, 105:1585–1591.PubMedCrossRefGoogle Scholar
  47. 47.
    The Digitalis Investigation Group: The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 1997, 336:525–533.CrossRefGoogle Scholar
  48. 48.
    Rathore SS, Wang Y, Krumholz HM: Sex-based differences in the effect of digoxin for the treatment of heart failure. N Engl J Med 2002, 347:1403–1411.PubMedCrossRefGoogle Scholar
  49. 49.
    Pires LA, Sethuraman B, Guduguntla VD, et al.: Outcome of women versus men with ventricular tachyarrhythmias treated with the implantable cardioverter defibrillator. J Cardiovasc Electrophysiol 2002, 13:563–568.PubMedCrossRefGoogle Scholar
  50. 50.
    Yusuf S, Sleight P, Pogue J, et al.: Effects of an angiotensin-converting-enzyme inhibitor, dramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000, 343:475–480.CrossRefGoogle Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • Denise D. Barnard
    • 1
  1. 1.University of California San Diego Heart Failure and Cardiac Transplant ProgramUCSD Medical CenterSan DiegoUSA

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