Herzinsuffizienz: Gibt es Geschlechterunterschiede?

Abstract

Heart failure is characterized by the presence of several sex/gender differences in prevalence, risk factor incidence, pathophysiology, symptoms, prognosis and interventional therapy. Women are affected more frequently by HFNEF (heart failure with normal ejection fraction), while men suffer more frequently from HFREF (heart failure with reduced ejection fraction). The effect of sexual hormones on these phenomena has been widely documented. Data on sex differences in therapeutic efficacy and side effects are lacking due to underrepresentation of women in clinical trials.

Kernaussagen

• Gender in engerem Sinn meint das „soziokulturelle Geschlecht”. Gender wird auch häufig als Oberbegriff zu Sex und Gender gebraucht und bezeichnet dann alle Geschlechterunterschiede.

• Die Prävalenz der chronischen Herzinsuffizienz ist bei beiden Geschlechtern stark abhängig vom Alter. Bei den 75 – 85-Jährigen sind 12 % der Frauen und 14,4 % der Männer herzinsuffizient.

• Bei Frauen ist eine HFNEF („heart failure with normal ejection fraction”) relativ häufiger, bei Männern eine HFREF („heart failure with reduced ejection fraction”).

• Arterielle Hypertonie und Diabetes mellitus sind die wichtigsten Risikofaktoren einer Herzinsuffizienz bei Frauen. Bei Männern steht die KHK im Vordergrund.

• Gesunde Frauen haben oft kleinere und steifere Ventrikel als Männer. Weibliche Herzen neigen bei Druckbelastung eher zu einer konzentrischen Hypertrophie mit erhaltener systolischer Funktion und diastolischer Dysfunktion, männliche eher zu systolischer Dysfunktion und Dilatation.

• Geschlechterunterschiede bei Herzinsuffizienz sind in Tiermodellen – Druck- und Volumenbelastung, Myokardinfarkt und transgene Modelle – nachvollziehbar.

• Endogene Östrogene haben bei Frauen und Männern positive und negative Effekte auf das Herz-Kreislauf-System; bei Frauen stehen Kardioprotektion und antiapoptotische Wirkung im Vordergrund.

• Depression ist eine häufige Komorbidität bei Herzinsuffizienz und betrifft Frauen häufiger als Männer.

• Daten zu Wirkungsprofilen zahlreicher kardiovaskulärer Arzneimittel fehlen aufgrund der Unterrepräsentation von Frauen in Arzneimittelstudien.

• Frauen erhalten im Vergleich zu Männern weniger ICDs, biventrikuläre Schrittmacher und werden seltener herztransplantiert. Dies könnte z. T. durch unterschiedliche Krankheitshäufigkeit zu erklären sein.

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