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(Circulation. 1999;99:2334-2341.)
© 1999 American Heart Association, Inc.
Current Perspective |
Failure of Women's Hearts
From the Medical Research Council Clinical Research Initiative in Heart Failure, Wolfson Building, University of Glasgow, and Department of Cardiology, Western Infirmary, Glasgow, Scotland.
Correspondence to Prof John J.V. McMurray, Medical Research Council Clinical Research Initiative in Heart Failure, Wolfson Building, University of Glasgow, Glasgow G11 6 NT, Scotland. E-mail J.McMurray@bio.gla.ac.uk
Key Words: women • heart failure • sex • epidemiology • prognosis
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Introduction |
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Recently, differences in the management of men and women with ischemic heart disease have been highlighted.1 Although at least as great, sex differences in heart failure have received little attention. In this article, we review the evidence that men and women with heart failure may differ with respect to epidemiology, etiology, diagnosis, prognosis, and treatment.
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Epidemiology |
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To date, most studies of the prevalence and incidence of heart failure have identified cases on clinical grounds and, in some instances, with the aid of an ECG and chest radiograph. Thus, the precise type of heart failure (eg, left ventricular systolic dysfunction, or valvular disease) is unclear in most reports. This is important in view of the evidence that left ventricular systolic dysfunction is less common in women than in men with suspected heart failure (see the "Diagnosis" section below).
Prevalence
With these caveats in mind, the major epidemiological surveys of
heart failure (see the
Figure
)2 3 4 5 show
that the overall prevalence rate of heart failure is similar in men and
women. This balance, however, reflects a much lower female prevalence
<70 to 75 years of age and a higher prevalence in older women than in
older men. Overall, within the population, there appear to be more
women than men with heart failure.6 7 8 Although
age-adjusted rates for both sexes have decreased from 1988–1995, rates
for women have fallen less than those for men.8B
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