Age and Sex Differences in Patients with Chronic Heart Failure
https://doi.org/10.37586/2949-4745-3-2023-134-142
Abstract
Introduction. The increasing burden of morbidity from heart failure, which is determined to be an age-related disease, new information about sex differences of this pathology determines the need of reviewing existing data on this problem particularly in older patients. The objective is to systematize data on gender differences in heart failure among older patients.
Materials and methods. A search of literature for 2011–2023 was conducted in the PubMed, Cochrane Library, Embase, Google Scholar databases, eLibrary. Data on sex and age differences of heart failure was included. The preferred languages were Russian and English. During the initial search, 4,228 sources were found. Full-text peer reviewed journal publications with the results of randomized and non-randomized clinical trials, meta-analyses, systematic reviews, and observational studies were selected.
Results and discussion. Gender differences in risk factors, epidemiology, pathophysiology, clinical manifestations, treatment of heart failure (HF), particularly in older and oldest-old patients were characterized. Presented information proves the need for a differentiated approach for managing patients of both sex with HF in advanced age.
Conclusion. It is necessary to develop new scientific programs and clinical recommendations for the differentiated management of patients with HF, including older and oldest-old patients in order to improve the prognosis and quality of life.
About the Authors
T. O. Brodovskaya
Ural State Medical University
Russian Federation
Russian Federation
Brodovskaya Tatyana O., MD, PhD, professor, Associate Professor, Head of the Department of Propaedeutics of Internal Diseases
Ekaterinburg
K. S. Vshivtsev
Central City Clinical Hospital №6
Russian Federation
Russian Federation
Vshivtsev Kirill S., Preventive medicine physician
Ekaterinburg
References
1. Tsao CW, Aday AW, Almarzooq ZI et al. Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association. Circulation. 2022;145(8):e153-e639. doi: 10.1161/CIR.0000000000001052
2. Riccardi M, Sammartino AM, Piepoli M, et al. Heart failure: an update from the last years and a look at the near future. ESC Heart Fail. 2022;9(6):3667–3693. doi: 10.1002/ehf2.14257
3. Savarese G, Becher PM, Lund LH et al. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2023;118(17):3272–3287. doi: 10.1093/cvr/cvac013
4. McDonagh TA, Metra M, Adamo M et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. EurJHeartFail. 2022; 24: 4–131. doi: 10.1093/eurheartj/ehab368
5. Lyasnikova E.A., Fedotov P.A., Trukshina M.A. et al. Management of heart failure patients in Russia: perspectives and realities of the second decade of the XXI century. Russian Journal of Cardiology. 2021;26(9):4658. (In Russ.) doi.org/10.15829/1560-4071-2021-4658
6. Lloyd-Jones DM, Larson MG, Leip EP et al. Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation. 2002;106:3068–3072. doi: 10.1161/01.cir.0000039105.49749.6f
7. Bleumink GS , Knetsch AM , Sturkenboom MC et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. Eur Heart J 2004;25:1614–1619. doi: 10.1016/j.ehj.2004.06.038
8. Magnussen C, Niiranen TJ, Ojeda FM et al. Sex-Specific epidemiology of heart failure risk and mortality in europe: results from the BiomarCaRE consortium. JACC Heart Fail. 2019;7:204–213. doi: 10.1016/j.jchf.2018.08.008
9. Bragazzi NL, Zhong W, Shu J, et al. Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017. Eur J Prev Cardiol. 2021;28(15):1682–1690. doi: 10.1093/eurjpc/zwaa147
10. Benjamin EJ, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56-e528. doi: 10.1161/CIR.0000000000000659
11. Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. CircHeartFail. 2013;6(3):606–619. doi: 10.1161/HHF.0b013e318291329a
12. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016;133(4):e38–360. doi: 10.1161/CIR.0000000000000350
13. Strömberg A, Mårtensson J. Gender differences in patients with heart failure. Eur J Cardiovasc Nurs. 2003;2(1):7–18. doi: 10.1016/S1474-5151(03)00002-1
14. Хроническая сердечная недостаточность. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(11):4083. [2020 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020;25(11):4083. (In Russ.)] doi:10.15829/1560-4071-2020-40
15. Fomin I.V. Chronic heart failure in Russian Federation: what do we know and what to do. Russian Journal of Cardiology. 2016;(8):7–13. (In Russ.) doi.org/10.15829/1560-4071-2016-8-7-13
16. Sillars A, Ho FK, Pell GP, et al. Sex differences in the association of risk factors for heart failure incidence and mortality. Heart. 2020;106:203-212. doi: 10.1136/heartjnl-2019-314878
17. Cesaroni G, Mureddu GF, Agabiti N et al. Sex differences in factors associated with heart failure and diastolic left ventricular dysfunction: a cross-sectional population-based study. BMC Public Health. 2021;21(1):415. doi: 10.1186/s12889-021-10442-3
18. Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol. 1974;34:29–34. doi: 10.1016/0002-9149(74)90089-7
19. He J, Ogden LG, Bazzano LA et al. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med. 2001;161:996–1002. doi: 10.1001/archinte.161.7.996
20. Eaton CB, Pettinger M, Rossouw J et al. Risk factors for incident hospitalized heart failure with preserved versus reduced ejection fraction in a multiracial cohort of postmenopausal women. Circ Heart Fail. 2016;9(10):e002883. doi: 10.1161/CIRCHEARTFAILURE.115.002883
21. Ambikairajah A, Walsh E, Tabatabaei-Jafari H et al. Fat mass changes during menopause: a meta-analysis. Am J Obstet Gynecol. 2019;221:393–409.e50. doi: 10.1016/j.ajog.2019.04.023
22. Mehta LS, Watson KE, Barac A et al. Cardiovascular Disease and Breast Cancer: where These Entities Intersect: a Scientific Statement From the American Heart Association. Circulation. 2018;137:e30–e66. doi: 10.1161/CIR.0000000000000556
23. Drafts BC, Twomley KM, D'Agostino RJr et al. Low to moderate dose anthracycline-based chemotherapy is associated with early noninvasive imaging evidence of subclinical cardiovascular disease. JACC Cardiovasc Imaging. 2013;6:877–885. doi: 10.1016/j.jcmg.2012.11.017
24. Chen J, Long JB, Hurria A et al. Incidence of heart failure or cardiomyopathy after adjuvant trastuzumab therapy for breast cancer. J Am Coll Cardiol. 2012;60:2504–2512. doi: 10.1016/j.jacc.2012.07.068
25. Narayan HK, Finkelman B, French B et al. Detailed echocardiographic phenotyping in breast cancer patients: associations with ejection fraction decline, recovery, and heart failure symptoms over 3 years of follow-up. Circulation. 2017;135:1397–1412. doi: 10.1161/CIRCULATIONAHA.116.023463
26. Saiki H, Petersen IA, Scott CG et al. Risk of heart failure with preserved ejection fraction in older women after contemporary radiotherapy for breast cancer. Circulation. 2017;135:1388–1396. doi: 10.1161/CIRCULATIONAHA.116.025434
27. Amir E, Seruga B, Niraula S et al. Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: a systematic review and meta-analysis. J Natl Cancer Inst. 2011;103:1299–1309. doi: 10.1093/jnci/djr242
28. Bairey Merz CN, Nelson MD, Cheng S et al. Sex differences and the left ventricle: morphology matters. Eur Heart J Cardiovasc Imaging. 2020;21(9):991–993. doi: 10.1093/ehjci/jeaa195
29. Chandramouli C, Teng T-HK, Tay WT et al. ASIAN-HF Investigators. Impact of diabetes and sex in heart failure with reduced ejection fraction patients from the ASIAN-HF registry. Eur J Heart Fail. 2019;21(3):297–307. doi: 10.1002/ejhf.1358
30. Pandey A, Omar W, Ayers C et al. Sex and race differences in lifetime risk of heart failure with preserved ejection fraction and heart failure with reduced ejection fraction. Circulation. 2018;137(17):1814– 1823. doi: 10.1161/CIRCULATIONAHA.117.031622
31. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/ AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;138:e484–e594 doi: 10.1161/HYP.0000000000000066
32. Shah SJ, Lam CSP, Svedlund S et al. Prevalence and correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction: PROMIS-HFpEF. Eur Heart J. 2018;39:3439–3450. doi: 10.1093/eurheartj/ehy531
33. Bairey Merz CN, Pepine CJ, Walsh MN et al. Ischemia and no obstructive coronary artery disease (INOCA): developing evidence-based therapies and research agenda for the next decade. Circulation. 2017;135(11):1075–92. doi: 10.1161/CIRCULATIONAHA.116.024534
34. Brodovskaya T.O., Arebev E.V., Grishina I.F. et al. Acute coronary syndrome in women. Are there any special features? Ural Medical Journal. 2023;22(4):128– 139. (In Russ.) doi.org/10.52420/2071-5943-2023-22-4-128-139
35. Regitz-Zagrosek V. Sex and Gender Differences in Heart Failure. IntJHeartFail. 2020;2(3):157–181. doi: 10.36628/ijhf.2020.0004
36. Dewan P , Rorth R , Jhund PS et al. Differential impact of heart failure with reduced ejection fraction on men and women. J Am Coll Cardiol. 2019;73:29–40. doi: 10.1016/j.jacc.2018.09.081
37. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. JAmSocEchocardiogr. 2015;28(1):1–39. doi: 10.1016/j.echo.2014.10.003
38. Bachmann KN, Huang S, Lee H et al. Effect of testosterone on natriuretic peptide levels. J Am Coll Cardiol. 2019;73:1288–96. doi: 10.1016/j.jacc.2018.12.062
39. Soldin OP, Mattison DR. Sex differences in pharmacokinetics and pharmacodynamics. Clin Pharmacokinet. 2009;48:143–157. doi: 10.2165/00003088-200948030-00001
40. Rosano GM, Lewis B, Agewall S et al. Gender differences in the effect of cardiovascular drugs: a position document of the Working Group on Pharmacology and Drug Therapy of the ESC. Eur Heart J.2015;36:2677–2680
41. Jochmann N, Stangl K, Garbe E et al. Female-specific aspects in the pharmacotherapy of chronic cardiovascular diseases. Eur Heart J.2005;26:1585–1595. doi: 10.1093/eurheartj/ehi397
42. CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987;316(23):1429–35. doi: 10.1056/NEJM198706043162301
43. RutherfordJD, PfefferMA, MoyeLAetal. Effects of captopril on ischemic events after myocardial infarction. Results of the Survival and Ventricular Enlargement trial. SAVE investigators. Circulation. 1994;90:1731–1738. doi: 10.1161/01.cir.90.4.1731
44. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. TheSOLVDinvestigators. N Engl J Med. 1991;325:293– 302. doi: 10.1056/NEJM199108013250501
45. ClelandJG, ErhardtL, MurrayG et al. Effect of ramipril on morbidity and mode of death among survivors of acute myocardial infarction with clinical evidence of heart failure. A report from the AIRE Study investigators. Eur Heart J. 1997;18:41–51
46. Yusuf S, Sleight P, Pogue J et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study investigators. N Engl J Med. 2000;342:145–153. doi: 10.1056/NEJM200001203420301
47. Santema BT, Ouwerkerk W, Tromp J et al. Identifying optimal doses of heart failure medications in men compared with women: a prospective, observational, cohort study. Lancet. 2019;394(10205):1254–1263. doi: 10.1016/S0140-6736(19)31792-1
48. Danielson C, Lileikyte G, Ouwerkerk W, S P Lam C, Erlinge D, Teng TK. Sex differences in efficacy of pharmacological therapies in heart failure with reduced ejection fraction: a meta-analysis. ESC Heart Fail. 2022;9(4):2753–2761. doi: 10.1002/ehf2.13974
49. Eugene AR. Gender based Dosing of Metoprolol in the Elderly using Population Pharmacokinetic Modeling and Simulations. Int J Clin Pharmacol Toxicol. 2016 May;5(3):209–215
50. Regitz-Zagrosek V. Sex and Gender Differences in Heart Failure. Int J Heart Fail. 2020;2(3):157–181. doi: 10.36628/ijhf.2020.0004
51. Lam CSP, Arnott C, Beale AL et al. Sex differences in heart failure. Eur Heart J. 2019;40(47):3859–3868c. doi: 10.1093/eurheartj/ehz835
52. Kotecha D, Manzano L, Krum H et al. Beta-Blockers in Heart Failure Collaborative Group. Effect of age and sex on efficacy and tolerability of β blockers in patients with heart failure with reduced ejection fraction: individual patient data meta-analysis. BMJ. 2016;353:i1855. doi: 10.1136/bmj.i1855
53. Harada E,Mizuno Y,Kugimiya F et al. Abstract 13269: GenderDifferenceofBeta-BlockerEffectinPatientsWithHeartFailurePres ervedEjectionFraction. Circulation. 2019;140:A13269
54. Tamargo J, Caballero R, Delpón E. Sex-related differences in the pharmacological treatment of heart failure. Pharmacol Ther. 2022;229:107891. doi: 10.1016/j.pharmthera.2021.107891
55. Merrill M, Sweitzer NK, Lindenfeld J et al. Sex Differences in Outcomes and Responses to Spironolactone in Heart Failure With Preserved Ejection Fraction: A Secondary Analysis of TOPCAT Trial. JACC Heart Fail. 2019;7(3):228–238. doi: 10.1016/j.jchf.2019.01.003
56. Rossello X, Ferreira JP, Pocock SJ et al. Sex differences in mineralocorticoid receptor antagonist trials: a pooled analysis of three large clinical trials. Eur J Heart Fail. 2020;22(5):834–844. doi: 10.1002/ejhf.1740
57. Regitz-Zagrosek V. Therapeutic implications of the gender-specific aspects of cardiovascular disease. Nat Rev Drug Discov. 2006;5:425–438. doi: 10.1038/nrd2032
58. van Veldhuisen DJ, Rienstra M, van der Meer P. Value of digoxin in patients with heart failure: new pieces to the puzzle. Eur J Heart Fail. 2018;20(7):1146–1147. doi: 10.1002/ejhf.1200
59. Zinman B, Wanner C, Lachin JM et al. EMPA-REG OUTCOME Investigators. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117–28. doi: 10.1056/NEJMoa1504720
60. Neal B, Perkovic V, Mahaffey KW et al. CANVAS Program Collaborative Group. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377(7):644–657. doi: 10.1056/NEJMoa1611925
61. Wiviott SD, Raz I, Bonaca MP et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019;380(4):347–357. doi: 10.1056/NEJMoa1812389
62. Perkovic V, Jardine MJ, Neal B et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019;380(24):2295–2306. doi: 10.1056/NEJMoa1811744
63. Rådholm K, Zhou Z, Clemens K et al. Effects of sodium-glucose co-transporter-2 inhibitors in type 2 diabetes in women versus men. Diabetes Obes Metab. 2020;22(2):263–266. doi: 10.1111/dom.13876
64. Rivera FB, Tang VAS, De Luna DV et al. Sex differences in cardiovascular outcomes of SGLT-2 inhibitors in heart failure randomized controlled trials: A systematic review and meta-analysis. Am Heart J Plus. 2023;26:100261. doi: 10.1016/j.ahjo.2023.100261
65. Solomon SD , McMurray JJV , Anand IS et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med.2019;381(17):1609–1620. doi: 10.1056/NEJMoa1908655
66. Klein L, Grau-Sepulveda MV, Bonow RO et al. Quality of care and outcomes in women hospitalized for heart failure. Circ Heart Fail. 2011;4(5):589–98. doi: 10.1161/CIRCHEARTFAILURE.110.960484
67. Lund LH, Braunschweig F, Benson L et al. Association between demographic, organizational, clinical, and socio-economic characteristics and underutilization of cardiac resynchronization therapy: results from the Swedish Heart Failure Registry. Eur J Heart Fail. 2017;19(10):1270–1279. doi: 10.1002/ejhf.781
68. Koitabashi N, Kass DA. Reverse remodeling in heart failure--mechanisms and therapeutic opportunities. Nat Rev Cardiol. 2011;9(3):147–57. doi: 10.1038/nrcardio.2011.172
69. Kormos RL, Cowger J, Pagani FD et al. The Society of Thoracic Surgeons Intermacs Database Annual Report: Evolving Indications, Outcomes, and Scientific Partnerships. Ann Thorac Surg. 2019;107(2):341–353. doi: 10.1016/j.athoracsur.2018.11.011
70. Blumer V, Mendirichaga R, Hernandez GA et al. Sex-specific outcome disparities in patients receiving continuous-flow left ventricular assist devices: a systematic review and meta-analysis. ASAIOJ. 2018;64:440–449. doi: 10.1097/MAT.0000000000000695
71. MagnussenC, BernhardtAM, OjedaFM, etal. Gender differences and outcomes in left ventricular assist device support: the European Registry for Patients with Mechanical Circulatory Support. JH eartLungTransplant.2018;37:61–70. doi: 10.1016/j.healun.2017.06.016
72. DeFilippis EM, Truby LK, Garan AR et al. Sex-Related Differences in Use and Outcomes of Left Ventricular Assist Devices as Bridge to Transplantation. JACC Heart Fail. 2019;7(3):250–257. doi: 10.1016/j.jchf.2019.01.008
73. Chambers DC, Cherikh WS, Harhay MO et al. International Society for Heart and Lung Transplantation. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult lung and heart-lung transplantation Report-2019; Focus theme: Donor and recipient size match. J Heart Lung Transplant. 2019;38(10):1042–1055. doi: 10.1016/j.healun.2019.08.001
74. Lewis EF, Lamas GA, O'Meara E et al. Characterization of health-related quality of life in heart failure patients with preserved versus low ejection fraction in CHARM. Eur J Heart Fail. 2007;9(1):83– 91. doi: 10.1016/j.ejheart.2006.10.012
75. Levy D, Kenchaiah S, Larson MG et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med. 2002;347(18):1397–402. doi: 10.1056/NEJMoa020265
76. Gerber Y, Weston SA, Redfield MM et al. L. A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern Med. 2015;175(6):996–1004. doi: 10.1001/jamainternmed.2015.0924
77. Lam CS, Carson PE, Anand IS et al. Sex differences in clinical characteristics and outcomes in elderly patients with heart failure and preserved ejection fraction: the Irbesartan in Heart Failure with Preserved Ejection Fraction (I-PRESERVE) trial. Circ Heart Fail. 2012;5(5):571–8. doi: 10.1161/CIRCHEARTFAILURE.112.970061
Review
For citations:
Brodovskaya T.O., Vshivtsev K.S. Age and Sex Differences in Patients with Chronic Heart Failure. Problems of Geroscience. 2023;(3):134-142. (In Russ.) https://doi.org/10.37586/2949-4745-3-2023-134-142
Views:
253
Email this article .jpg)
