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Sex and gender differences in myocardial hypertrophy and heart failure

Geschlechterunterschiede in Myokardhypertrophie und Herzinsuffizienz

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Zusammenfassung

Kardiovaskuläre Erkrankungen sind die häufigste Todesursache bei Männern und Frauen. Männer entwickeln kardiovaskuläre Erkrankungen häufiger in einem jüngeren, Frauen in einem späten Alter. Herzinsuffizienz (HF) führt zu einer signifikanten Verschlechterung der Lebenserwartung und ist für beide Geschlechter ungünstig. Risikofaktoren und myokardiale Anpassungsreaktionen bei HF unterscheiden sich bei Männern und Frauen. Frauen entwickeln mehr physiologische Hypertrophie, während Männer eher exzentrische Hypertrophie und Dilatation entwickeln. Das mag mit Sexualhormonen, Östrogenen und Androgenen zusammen hängen. Eine klinische Studie zu Geschlechterunterschieden bei menschlicher Aortenstenose unterstützt unsere Hypothese. Die Behandlung der Herzinsuffizienz unterscheidet sich bei beiden Geschlechtern, Frauen werden weniger intensiv behandelt. Allerdings haben sie dennoch meistens einen günstigeren Verlauf. Genderspezifische Medizin wird direkt zu einer Verbesserung des Managements bei Frauen und Männern beitragen.

Summary

Cardiovascular disease is the most common cause of death in men and women worldwide. Men develop most, but not all, cardiovascular diseases at an earlier age while the number of affected women significantly increases with higher age. Heart failure (HF) is a common cause of cardiovascular death and carries a poor prognosis in both genders. Risk factors and myocardial adaptations in HF in men and women are different. Female hearts develop a more favorable physiological form of myocardial remodeling than male hearts. This may be related to sex hormones, estrogens and testosterone. A clinical study for gender differences in human aortic stenosis supports the hypotheses. HF management differs between both sexes, with underdiagnosis and undertreatment and less use of invasive therapies in women. Nevertheless, women frequently have better outcomes than men. Gender research will contribute directly to patient-oriented benefit by suggesting clinical protocols.

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Abbreviations

AR:

androgen receptor

AS:

aortic stenosis

AVR:

aortic valve replacement

DCM:

dilated cardiomyopathy

E2:

estradiol

ECM:

extracellular matrix

ER:

estrogen receptor

HF:

heart failure

LVH:

left ventricular hypertrophy

MH:

myocardial hypertrophy

MMP:

matrix metalloproteinases

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Authors and Affiliations

  1. Institute of Gender in Medicine (GiM) and Center for Cardiovascular Research (CCR), Charité University Medicine, Berlin, Germany

    Vera Regitz-Zagrosek

  2. Center for Gender in Medicine (GiM), Charité University Medicine, Berlin, Germany

    Ute Seeland

  3. German Heart Institute (DHZB), Berlin, Germany

    Vera Regitz-Zagrosek

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  1. Vera Regitz-Zagrosek
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  2. Ute Seeland
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Correspondence to Vera Regitz-Zagrosek.

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Regitz-Zagrosek, V., Seeland, U. Sex and gender differences in myocardial hypertrophy and heart failure. Wien Med Wochenschr 161, 109–116 (2011). https://doi.org/10.1007/s10354-011-0892-8

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  • DOI: https://doi.org/10.1007/s10354-011-0892-8

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