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women. In 2010, 32,847 deaths in women were due to heart failure, which accounted
for more deaths in women than in men. The prevalence of heart failure increases with
age, with more women than men having heart failure after 79 years of age. Although
the lifetime risk for the development of heart failure in a 40 year old individual is not
different between the sexes, the lifetime risk for the development of heart failure in a
40 years old individual without a preceding myocardial infarction is 1 in 6 for women
versus 1 in 9 for men.
The risk factors associated with heart failure and its underlying pathophysiology
differ by sex. Women with heart failure have more hypertension, valvular heart
disease and thyroid disorders than men do but are less likely to have obstructive
coronary artery disease. Even though obstructive coronary artery disease is less
frequent in women, it is a stronger risk factors in women include cardiac toxicity from
the chemotherapeutic drugs used for the treatment of breast cancer and peripartum
cardiomyopathy. Women with acute decompensated heart failure are twice as likely
as men to have preserved left ventricular function or heart failure with a preserved
ejection fraction. Even women with an impaired left ventricular ejection fraction will
have a higher left ventricular ejection fraction than men do. Notably, women with
heart failure have a lower quality of life, lower depression. Nonetheless, overall
survival is better for women than for men with heart failure. This finding not only
results from women having more heart failure with a preserved ejection fraction
because mortality rates from heart failure do not relate to preserved or impaired
ejection fraction in either sex, altough those with ischemic cardiomypathy have a
worse prognosis.
Peripartum cardiomyopathy
Treatment of heart failure may benefit both sexes esqually, but the
underrepresentation of women in heart failure trials and the more prevalent heart
failure with a preserved ejection fraction in women contribute to our lack of evidance
regarding treatment of heart failure in women. The candesartan in heart failure :
Assesment of reduction in mortality and morbidity trials, along with others, showed
that women were more likely to have preserved left ventricular function 50% than
men were 35%. Overall, evidence base heart failure therapies are underused in both
sexes, and although women are less likely than men to received them, this disparity
did not translate into a higher rate of hospitalization for heart failure or mortality.
Women are less likely to receive vasoactive agent, but men and women have equal
length of hospitalization and age adjusted in hospital heart failure mortality rate.
Primary and secondary prevention of sudden cardiac death in heart failure with
the use of implantable cardioverter defibrilator devices demonstrate sex differences.
Cairdioverter defibrilator devices are underuse in both sex. Particularly so in women.
Eligible women, especially black women are less likely than men to receive a
cardioverter defibrilator devices. Cardioverter defibrilator devices use increase
overtime, and the racial diparities disappear by 2009, but the sex disparities have
persisted none of the randomized trials for cardioverter defibrilator devices and rolled
sufficient numbers of women to permit analysis of sex differences. All studies to date
are underpowered to detect sex differences, but cardioverter defibrilator devices do
not clearly demonstrate a mortality benefit in women. Women have similiar
implantation rate but they also have greater complication rate both at 45 days and 1
year. Although there were no sex differences in mortality. Early complication
consisted of lead repositioning in men and lead replacement in women, and late
complication for both sexes included pocket infection and electrical strorm. In
addition women were less likely to receive appropriate therapy via shock or
antitachycardia pacing than men were. These differences may result from sex
differences in body size. Delay evaluation in women or simply innate differences in
respons to disease.
Cardiac transplantation
Heart transplantation occures far less frequently in women than in men, with only
28% of heart transplant in the United State in 2011 occuring in women. This may
result from the older age of women with heart failure and differences in choices
related to transplantation. Survival after transplantation does appeared to be slightly
worse in women than in men, with the survival gap increaseng slightly with time.
Certain specific therapy list as class III intervention, are advised against, either as
a result of no demonstrated benefit of effectiveness or when the risk outweigh any
potential benefit. Such treatment includes hormon replacement therapy outside the
indication for menopausal symptoms, antioxidant vitamin supplement, folic acid
supplement, and routine use of aspirin in healthy women younger than 65 years.
Conclusion