Sex differences in heart failure

This thesis examined differences between men and women with heart failure. First, it was shown that biological sex is a strong modulator in the clinical expression of various cardiomyopathies. In the general population it was shown that men are more likely to develop heart failure with reduced ejection fraction and also at a younger age. This is mainly due to myocardial infarction. On the other hand, women are at higher risk of developing heart failure with preserved ejection fraction, especially with older age and with atrial fibrillation. In chronic heart failure female sex is strongly associated with specific clinical features, such as advanced age, hypertension, a preserved ejection fraction, and they often have symptoms of congestion. Regardless of these differences, women have a better prognosis. However, it is unclear whether the biological background affects this survival benefit in women. Inflammation parameters and other biomarkers were significantly lower in women compared to men with heart failure, and some also have a gender prognostic value. In acute heart failure women have specific co-morbidities, such as hypertension, diabetes and depression, compared with men. During hospitalization for acute heart failure the biological status of heart failure is less advanced in women compared to men and this could possibly explain the differences in prognosis. It also appears that female sex is an independent predictor of relief from dyspnea, regardless of other factors.