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Sex-specific differences in risk factors, comorbidities, diagnostic challenges, optimal management, and prognostic outcomes of heart failure with preserved ejection fraction: A comprehensive literature review

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Abstract

Due to hormonal variations, heart failure with preserved ejection fraction (HFpEF) remains prevalent in women and affects almost half of the heart failure (HF) patients. Given the yearly death rate of 10–30% and the unavailability of medications targeting HFpEF, the need arises for a better understanding of the fundamental mechanisms of this syndrome. This comprehensive review explores sex-specific differences in traditional risk factors; female-specific factors that may impact HFpEF development and response to therapy, including variations in hormone levels that may occur pre- and post-menopausal or during pregnancy; and disparities in comorbidities, clinical presentation, and diagnostic challenges. Lastly, the review addresses prognostic outcomes, noting that women with HFpEF have a poor quality of life but a higher survival rate. It also discusses novel biomarkers and precision medicine, emphasizing their potential to improve early detection and personalized treatment.

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We thank Dr. Munazza Khan from Medical University, Pleven, who performed native English language editing for our research article. All figures are created with BioRender.

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  1. Department of Internal Medicine, Ameer-Ud-Din Medical College, Lahore General Hospital, 6 Birdwood Road, Jinnah Town, Lahore, Punjab, 54000, Pakistan

    Muhammad Abubakar

  2. Department of Internal Medicine, Jinnah Hospital, Lahore, Punjab, Pakistan

    Ayesha Saleem, Mohsin Hajjaj & Haseeb Faiz

  3. Department of Internal Medicine, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

    Aastha Pragya

  4. Department of Internal Medicine, Mayo Hospital, Lahore, Punjab, Pakistan

    Rosheen Jamil

  5. Department of Surgery, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh

    Siffat Saima Salim

  6. Department of Internal Medicine, Medical University - Pleven, Pleven, Bulgaria

    Ibrahim Khaleel Lateef

  7. Department of Internal Medicine, Government Medical College, Patiala, Punjab, India

    Deepak Singla

  8. Department of Internal Medicine, Rajah Muthiah Medical College, Chidambaram, Tamil Nadu, India

    Rajasekar Ramar

  9. Department of Internal Medicine, Universitas Indonesia, Jakarta, Indonesia

    Ivan Damara

  10. Department of Dermatology, Lahore General Hospital, Lahore, Punjab, Pakistan

    Laraib Shahid

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Abubakar, M., Saleem, A., Hajjaj, M. et al. Sex-specific differences in risk factors, comorbidities, diagnostic challenges, optimal management, and prognostic outcomes of heart failure with preserved ejection fraction: A comprehensive literature review. Heart Fail Rev 29, 235–256 (2024). https://doi.org/10.1007/s10741-023-10369-4

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