Gender- and sex-dependent variations in heart failure and cardiomyopathies: a review of the literature

Heart failure (HF) is a clinical syndrome that can present as an acute or chronic condition resulting from various cardiovascular (CV) diseases. It poses a significant global health burden and affects individuals regardless of biological sex. HF can be caused by various differing etiologies exhibiting different rates of disease progression and mortality. Treatment of HF is often approached using a one-size-fits-all strategy that overlooks sex and gender differences, relying solely on left ventricular ejection fraction as the clinical parameter. This is due to a lack of evidence and subsequent missing deepened understanding of nuances of disease manifestation, course, and outcome. Biological sex (defined as biological aspects of having female or male body) and gender (society norms and roles of women and men) are known to substantially influence prognosis, age of disease onset, as well as severity in CV disease and subsequent HF. However, varying quality and availability of supporting evidence and subsequently unmet diagnostic and therapeutic needs exist for general HF and cardiomyopathy (CM) management. This review aims to elucidate the influence of sex and gender on the development and treatment of HF and CM as a basis for advancing personalized diagnosis and treatment strategies.