There are many important differences between women and men with heart failure (HF), highlighting the importance of sex-specific strategies for prevention and treatment, according to three papers in a special focused issue on HF in women, published Feb. 25 in JACC: Heart Failure.

A state-of-the-art review paper by Melissa A. Daubert, MD, FACC, and Pamela S. Douglas, MD, MACC, looks at the primary prevention of HF in women. They examine the different efforts that should be taken to prevent HF in women, noting that women with HF are generally older, have a higher BMI and have a greater prevalence of hypertension, diabetes and kidney disease. Women are more likely to have HF with preserved ejection fraction (HFpEF), while men are more likely to have HF with reduced ejection fraction. Atrial fibrillation (AFib) has also been shown to have a sex-specific predictive value for the development of HFpEF in women. Interventions targeted at maintaining or achieving a health body weight and reducing risk factors, especially hypertension and AFib, may help to lower the rates of HF in women. Additionally, pregnancy complications, breast cancer treatments and menopause can all increase the risk of HF in women.

In another state-of-the-art review paper, Petra Zubin Maslov, MD, PhD, et al., note that postmenopausal women display an exponential increase in the incidence of HFpEF compared to men of the same age, indicating that hormonal changes may affect heart function. They explain that changes in heart function and structure are often seen in older age in both men and women, and are more pronounced in postmenopausal women compared to premenopausal women. In women at a lower risk for HF, estrogen deficiency combined with other risk factors such as hypertension, diabetes or obesity might lead to the development of full-blown clinical syndrome. The conclude that studies have inconclusively found that hormone replacement therapy could improve heart function in postmenopausal women, but more clinical trials and data are still needed.

Meanwhile, a separate study by Ann Banke, MD, et al., found that trastuzumab treatment has been shown to significantly improve the outcomes of patients with a certain kind of breast cancer, but it is also associated with a two-fold increased risk of HF compared to other chemotherapy regimens. The study looked at 2,117 patients with HER2 positive breast cancer who received both chemotherapy and trastuzumab, vs. 6,695 HER2 negative patients who received chemotherapy only. After a median follow-up period of 5.4 years, 2.7 percent of patients who received trastuzumab developed new cases of HF compared to 0.8 percent who received chemotherapy only. The cumulative incidence of HF after nine years was 3.3 percent in the trastuzumab group compared to 1.3 percent in the chemotherapy only group. The authors conclude that their results demonstrate a significant increase in both early and late HF among patients treated with both chemotherapy and trastuzumab compared to chemotherapy alone but with an overall low incidence. In a related editorial comment, Ana Barac, MD, PhD, FACC, chair of ACC's Cardio-Oncology Section, notes, "future research is critically needed to identify cardiac therapeutic strategies during treatment and survivorship to demonstrate improvement in cardiovascular outcomes in this patient cohort."

In an editor's page, JoAnn Lindenfeld, MD, FACC, and JACC: Heart Failure Editor-in-Chief Christopher M. O'Connor, MD, MACC, write that the goals of the special focused issue are to increase awareness in these differences between HF in men and women, to encourage research that looks at the outcomes by sex, and to provide patients with the information and knowledge needed to make informed decisions and be ensured they are receiving the best care.

Check out the special focused issue of JACC: Heart Failure.

Clinical Topics: Arrhythmias and Clinical EP, Cardio-Oncology, Heart Failure and Cardiomyopathies, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension

Keywords: Cardiotoxicity, Female, Atrial Fibrillation, Stroke Volume, Postmenopause, Body Weight, Heart Failure, Obesity, Diabetes Mellitus, Hypertension, Breast Neoplasms, Hormone Replacement Therapy, Pregnancy Complications, Primary Prevention, Kidney Diseases, Estrogens

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