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Sex differences and related estrogenic effects in heart failure with preserved ejection fraction

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Abstract

Heart failure with preserved ejection fraction (HFpEF) is an essential subtype of heart failure accounting for 40% of the total. However, the related pathological mechanism and drug therapy research have been stagnant for a long time. The direct cause of this dilemma is the heterogeneity of HFpEF. And some researchers believe that there is no common pathway to reach the origin of HFpEF; others argue that there is an unidentified unified pathophysiological process hidden beneath the ice surface. Aside from the debate, a series of clinical studies have shown that hypertension and obesity play a fundamental role in the pathogenesis of HFpEF. These results imply that there may be two parallel pathological processes interweaved in one disease, manifested as multiple coexistent pathological phenomena, like a shadow. Meanwhile, the prevalence of HFpEF in women is higher than in men in any given age group, especially prominent in elderly patients. These pathological processes and epidemiological data reflect gender differences, reminding us to shift our attention to estrogen. This article will review the parallel pathogenesis of HFpEF, and also introduce sex differences and the potential effect of estrogen in this condition below.

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Funding

This study is supported by National Natural Science Foundation of China (No.82274436) and Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine (No. ZYYCXTD-C-202207).

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Authors and Affiliations

  1. First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China

    Deng Shuaishuai, Lin Jingyi, Zhao Zhiqiang & Fan Guanwei

  2. National Clinical Research Center for Chinese Acupuncture and Moxibustion, Tianjin, China

    Deng Shuaishuai, Lin Jingyi, Zhao Zhiqiang & Fan Guanwei

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  1. Deng Shuaishuai
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  2. Lin Jingyi
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  4. Fan Guanwei
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DSS, LJY, ZZQ, and FGW contributed to manuscript conceptualization and design. DSS and FGW contributed to first draft writing. All authors contributed to manuscript writing and critical review. All authors have read the final version of the manuscript and agreed to its submission.

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Correspondence to Fan Guanwei.

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Shuaishuai, D., Jingyi, L., Zhiqiang, Z. et al. Sex differences and related estrogenic effects in heart failure with preserved ejection fraction. Heart Fail Rev 28, 937–948 (2023). https://doi.org/10.1007/s10741-022-10274-2

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