Heart Failure Different in Women

Study Explores Gender Differences in Risk Factors, Survival

By Salynn Boyles
WebMD Health News

Reviewed By Elizabeth Klodas, MD, FACC

July 27, 2009 -- Women with heart failure live longer than men with the disease, but they have more illness and hospitalizations and poorer overall quality of life, a review of the research shows.

The analysis confirms that men and women often have different risk factors for developing heart failure, and it suggests that responses to treatment may also vary by gender.

But study co-author Eileen M. Hsich, MD, of Cleveland Clinic's Women's Heart Failure Clinic, says far too little is known about how gender affects treatment because women are still underrepresented in clinical studies and most heart failure trials do not report results in a sex-specific way.

"These treatments must be working because women are living longer than men, but we don't know as much as we should about this," she tells WebMD. "In order to change the future, more women with heart failure or any cardiovascular disease, need to be aggressive about participating in studies. They should not wait for their doctor to approach them."

Half of Heart Failure Patients Are Women

According to the American Heart Association, about 5.3 million Americans are living with heart failure, and half of them are women.

Heart failure describes the inability of the heart to pump enough blood to meet the body's demands.

It be caused by a weakened heart muscle that doesn't contract with enough force to push blood out to the body (systolic heart failure) or because the pumping chamber does not relax properly, reducing the amount of blood available to enter the heart (diastolic heart failure).

According to the review, which appears in the Aug. 4 issue of the Journal of the American College of Cardiology, about 70% of men with heart failure have a weakened heart muscle as the cause, compared to about 40% of women.

Women are more likely than men to have high blood pressure and heart valve damage as the cause of heart failure; men are more likely to have coronary artery disease.

But when women do develop coronary artery disease, they are more likely than men to also develop heart failure.

In one national survey, which included more than 8,000 women with heart failure, more than a fourth (27%) had high blood pressure and just 3% had coronary artery disease.

But having coronary artery disease was more likely to lead to heart failure among women than high blood pressure.

Other sex-specific differences identified in the review included:

  • As with heart disease in general, women tend to be older than men when they develop heart failure.
  • Survival among women with heart failure is better than for men with the disease. The reasons for this remain unclear.
  • Women with heart failure are more likely to be sicker than men and have more hospital stays. They are also more likely to suffer from depression than men.

Does Gender Affect Treatment Outcomes?

The retrospective analysis suggests that gender may be a factor in the effectiveness of certain heart failure treatments.

Treatment benefits were seen in women with heart failure who received beta-blockers, aldosterone antagonists, and pacemakers.

Clear benefits were not seen with other treatments including ACE inhibitors and implantable defibrillators, but Hsich says this doesn't mean these therapies are not useful in women.

"My guess is all these treatments work, but some may not work as well as they do in men," she says. "We need more trials with sex-specific data to figure this out."

Cardiologist Nieca Goldberg, MD, medical director of New York University's Women's Heart Program and author of several books exploring heart health in women, agrees.

"Clearly we need more studies examining sex-specific differences in responses to the treatments for heart failure and heart disease in general," she tells WebMD.

She says campaigns by the American Heart Association and the National Heart, Lung, and Blood Institute have succeeded in raising awareness about the importance of aggressively treating heart symptoms in women.

But she adds that too little is known about how gender affects heart disease diagnosis, treatment, and outcomes.

"Women need to be asked to participate, and they need to be willing to participate in clinical trials," she says. "Even if it doesn't help them, it might help their daughters and granddaughters."

SOURCES: Hsich, E.M. Journal of the American College of Cardiology, Aug. 4. 2009; vol 54: pp 491-498. Eileen M. Hsich, MD, director, Women's Heart Failure Clinic, Cleveland Clinic, Ohio. Nieca Goldberg, MD, clinical associate professor of medicine and medical director, NYU Women's Heart Program, New York. American Heart Association: "Heart disease and stroke statistics: 2008 Update." WebMD Medical Reference: "Heart Failure Overview.

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