At proCardio 2022, the Global Cardiac Biomarker Forum, Prof Emily Lau (Massachusetts General Hospital, Boston, USA) spoke about sex-specific differences in heart failure (HF), highlighting that “heart failure is fundamentally different in men and women” describing several sex-specific differences ranging across pathophysiology, risk factors, diagnosis and outcomes.1,2
Regarding pathophysiology, Prof Lau noted that the main driving factor of HF development in men is known to be apoptosis or loss of cardiomyocytes. Whereas in women, coronary microvascular dysfunction and accompanying downstream effects seem to be more important.3 With respect to disease manifestation and outcomes, Prof Lau explained that HF seems to have a greater impact on quality of life and exercise intolerance in women, even though their disease prognosis is typically better compared to men.4-9 Interestingly, when it comes to treatment, she noted there may also be sex-specific differences in treatment responses, referring to data suggesting that ARNI may have a beneficial effect in women compared to men with HFpEF.10
Prof Lau also discussed how sex can influence biomarkers, noting that baseline levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) are higher in healthy women compared to men, which is attenuated in people with HF.3,11,12 She also explained how the ability of NT-proBNP to predict outcomes might be greater in men versus women, although data on this is conflicting.11-13 Prof Lau commented how interpretation of biomarker levels in women is further complicated by hormonal and menopause status, for example, NT-proBNP levels are lowest in men and highest in pre-menopausal women on contraceptives.14,15
Finally, Prof Lau highlighted that, despite these fundamental differences in men and women, treatment is currently still the same.16,17 She believes that taking these sex-specific differences into account when adjusting therapy would allow for truly personalised and, more importantly, effective patient care.