However, recent evidence has shown no significant sex-related differences in terms of infections, bleeding, or device malfunction (26, 101, 102). of paradoxical low flow- low gradient stenosis. More frequent concomitant significant mitral disease. Similar survival rates after surgery. Lower all-cause mortality after TAVR.(61C64)Tricuspid regurgitationHigher prevalence. Similar results in isolated surgery, but poorer perioperative outcomes when combined with coronary artery bypass surgery.(65, 66)Other cardiomyopathiesHypertrophic cardiomyopathyHigher prevalence (2:1 predominance in males). More hypertrophy and fibrosis. More ventricular arrhythmiasWorse symptoms Higher all-cause mortality(67, 68)Arrhythmogenic cardiomyopathyHigher prevalence (approximate ratio of 3:1). Higher mortality rate and sudden cardiac death.(69, 70)Restrictive cardiomyopathyMale predominance in mutant and Wild-type transthyretin amyloid. More frequent Cardiac involvement in sarcoidosis.Higher occurrence of endomyicardial fibrosis, but better survival. No sex differences for hyper-eosinophilic syndrome, scleroderma or carcinoid heart disease.(52, 71) Open in a separate window analyses and registries, with their inherent bias (26). This has limited our understanding of the efficacy of HF treatment in women (72). Moreover, it has been shown that women are less likely to receive guideline-proven HF therapies than men, and more frequently receive suboptimal doses (11, 40). However, adherence Rabbit polyclonal to ZFP161 to HF treatments is higher in women than in men (73, 74). Drugs to Treat HF With Reduced Ejection Fraction Women with HF and reduced ejection fraction receive significantly less furosemide than men, both at admission and during hospitalizations (12, 75). Regarding angiotensin-converting enzyme (ACE) inhibitors, the benefit for women may not be as great as for men, with particular doubts concerning its value in women with still asymptomatic LV systolic dysfunction (76, 77). However, this is probably related with limited power due to the low representation of women in studies (78). Conversely, the effect of angiotensin receptor blockers (ARB) seems to be similar in both sexes (79). Sacubitril/valsartan has a similar tolerability in men and women with more frequent functional class improvement and greater reduction in the risk of HF hospitalization in women than in men (80, 81). The data regarding hydralazine and isosorbide dinitrate in females are extremely scarce, being particularly surprising given that this combination is frequently used to treat HF during pregnancy, when ACE inhibitors and ARBs are contraindicated. Besides, spironolactone and eplerenone improve survival in symptomatic systolic HF in men and women (82C84) (Figure 2). Open in a separate window Figure 2 Possible sex-related differences in the benefit of heart failure drugs. Thumb up means data that suggest higher benefit in women than in men. Thumb down means the opposite. On the other hand, betablockers improve outcomes in women, even though the main benefits in most studies were related to the reduction in hospitalizations (85C87). At any rate, meta-analyses data have confirmed that the effect of betablockers in mortality reduction is similar in both sexes (76). Less than 25% of patients in ivabradine trials were women. Despite the limited evidence, there is no reason to think that their main benefit, the reduction in hospital admissions, is different in men and women (88). In contrast, a previous study yielded worrying results regarding digoxin use in women due to its possible association with an increased risk of death. Digoxin use and dosage should, therefore, be very cautious in women (89). Finally, sodium glucose co-transporter 2 (SGLT2) inhibitors have demonstrated benefits in terms of cardiovascular mortality and especially in lowering the risk of HF hospitalization (90) and the benefit seems to be similar in women and men (91). Devices Women are less often CNX-774 considered eligible for implantable CNX-774 cardioverter defibrillator (ICD) implantation, and even after adjustment for potential confounders, women are 40% less likely to receive ICD therapy than men (92C94). This is not justified by a lower efficacy in this subgroup, since previous studies have shown similar ICD effectiveness in both sexes (48). Regarding resynchronization therapy (CRT), women CNX-774 are, once again, significantly less likely to undergo CRT implant compared to men despite its demonstrated CNX-774 greater benefit (95). Among patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) trial, women treated with CRT experienced greater reductions in the combined endpoint of HF.