Гендерная кардиология: клинико-патофизиологические особенности течения основных заболеваний у женщин
Автор: Давыдкин И.Л., Кузьмин В.П., Золотовская И.А., Хайретдинов Р.К., Кривова С.П., Рубаненко О.А.
Журнал: Евразийский кардиологический журнал @eurasian-cardiology-journal
Рубрика: Обзор
Статья в выпуске: 2, 2024 года.
Бесплатный доступ
Ишемическая болезнь сердца (ИБС) является ведущей причиной смерти как женщин, так и мужчин. Женщины в более старшем возрасте, когда впервые проявляется ИБС, имеют больше сопутствующих заболеваний и, как правило, жалуются на нетипичные симптомы. Смертность и частота госпитализаций при остром инфаркте миокарде выше у женщин. Необходимо отметить, что приверженность к вторичной профилактике у женщин ниже.Преобладание женского пола отмечается при идиопатической легочной артериальной гипертензии, наследственной легочной гипертензии и связанной с коллагенозами легочной артериальной гипертензией. Однако последние данные европейского регистра COMPERA показали, что гендерные различия исчезают у пациентов в пожилом возрасте и при наличии сопутствующих заболеваний. Рассматривается более частая встречаемость кардиомиопатий среди женщин. Перипартальная кардиомиопатия, связанная с беременностью и родами, и кардиомиопатия Такоцубо, обусловленная психоэмоциональным напряжением, в частности стрессовой ситуацией, определяет дальнейший прогноз женщины. Нарушения ритма объясняются изменением гормонального статуса на фоне беременности, менопаузы или связаны с дебютом основного заболевания.Сердечная недостаточность обычно поражает оба пола в равной степени, при этом женщины чаще страдают СНсФВ, а мужчины СНнФВ. Классические сердечно-сосудистые, гендерные и социальные факторы риска сердечно-сосудистых заболеваний и сердечной недостаточности имеют иное значение у женщин, чем у мужчин. Необходимо учитывать параметры при ЭхоКГ диагностике у женщин, поскольку размеры сердца у женщин меньше.
Сердечно-сосудистые заболевания, женский пол, нарушения ритма, кардиомиопатия, легочная гипертензия
Короткий адрес: https://sciup.org/143182949
IDR: 143182949 | DOI: 10.38109/2225-1685-2024-2-114-121
Список литературы Гендерная кардиология: клинико-патофизиологические особенности течения основных заболеваний у женщин
- Wilmot KA, O’Flaherty M, Capewell S. et al. Coronary Heart Disease Mortality Declines in the United States From 1979 Through 2011: Evidence for Stagnation in Young Adults, Especially Women. Circulation 2015; 132(11):997-1002. https://doi.org/10.1161/CIRCULATIONAHA.115.015293
- Lyon AR, Citro R, Schneider B. et al. Pathophysiology of takotsubo syndrome - JACC state-of-the-art review. J Am Coll Cardiol 2021;77:902-921. https://doi.org/10.1016/j.jacc.2020.10.060
- Болотова Е.В., Дудникова А.В., Крутова В.А.,Багдасарян А.С., Особенности течения сердечно-сосудистых заболеваний у женщин. Профилактическая медицина .2020;23(6):107-113.
- Canto JG, Rogers WJ, Goldberg RJ. et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA 2012;307:813-822. https://doi.org/10.1001/jama.2012.199
- Anand SS, Islam S, Rosengren A. et al. Risk factors for myocardial infarction in women and men: insights from the INTERHEART study. Eur Heart J 2008;29:932-940. https://doi.org/10.1093/eurheartj/ehn018
- Puymirat E, Simon T, Steg PG. et al. Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction. JAMA 2012;308:998-1006. https://doi.org/10.1001/2012.jama.11348
- Yusuf S, Hawken S, Ounpuu S. et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004;364:937-952. https://doi.org/10.1016/S0140-6736(04)17018-9
- Huxley RR, Peters SAE, Mishra GD. et al. Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2015;3:198-206. https://doi.org/10.1016/S2213-8587(14)70248-7
- Mnatzaganian G, Hiller JE, Braitberg G. et al. Sex disparities in the assessment and outcomes of chest pain presentations in emergency departments. Heart 2020;1016:111-118. https://doi.org/10.1136/heartjnl-2019-315667
- Le-Ha C, Beilin LJ, Burrows S. et al. Oral contraceptive use in girls and alcohol consumption in boys are associated with increased blood pressure in late adolescence. Eur J Prev Cardiol 2013;20:947-955. https://doi.org/10.1177/2047487312452966
- Spracklen CN, Smith CJ, Saftlas AF. et al. Maternal hyperlipidemia and the risk of preeclampsia: a meta-analysis. Am J Epidemiol 2014;180:346-358. https://doi.org/10.1093/aje/kwu145
- Izadnegahdar M, Mackay M, Lee MK. et al. Sex and Ethnic Differences in Outcomes of Acute Coronary Syndrome and Stable Angina Patients With Obstructive Coronary Artery Disease. Circ Cardiovasc Qual Outcomes. 2016;9(01):26-35. https://doi.org/10.3390/jcdd9080239
- Pelletier R, Humphries KH, Shimony A. et al. Sex-related differences in access to care among patients with premature acute coronary syndrome. CMAJ 2014;186:497-504. https://doi.org/10.1503/cmaj.131450
- Hemal K, Pagidipati NJ, Coles A. et al. Sex differences in demographics, risk factors, presentation, and noninvasive testing in stable outpatients with suspected coronary artery disease: insights from the PROMISE trial. JACC Cardiovasc Imaging 2016;9:337-346. https://doi.org/10.1016/j.jcmg.2016.02.001
- Mosca L, Benjamin EJ, Berra K. et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women 2011 - update: a guideline from the American Heart Association. Circulation 2011;123:1243-1262. https://doi.org/10.1161/CIR.0b013e31820faaf8
- Graham G. Acute coronary syndromes in women: recent treatment trends and outcomes. Clin Med Insights Cardiol 2016;10:1-10. ECollection 2016. https://doi.org/10.4137/CMC.S37145
- D’Ascenzo F, Gili S, Bertaina M. et al. Impact of aspirin on takotsubo syndrome: a propensity score-based analysis of the InterTAK Registry. Eur J Heart Fail 2020;22:330-337. https://doi.org/10.1002/ejhf.1698
- Linde C, Bongiorni MG, Birgersdotter-Green U. et al. Sex differences in cardiac arrhythmia: a consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society. Europace 2018;20:1565-1565. https://doi.org/10.1093/europace/euy067
- Singh JA, Lu X, Ibrahim S. et al. Trends in and disparities for acute myocardial infarction: an analysis of Medicare claims data from 1992 to 2010. BMC Med 2014;12:190. https://doi.org/10.1186/s12916-014-0190-6
- Champney KP, Frederick PD, Bueno H. et al. The joint contribution of sex, age and type of myocardial infarction on hospital mortality following acute myocardial infarction. Heart 2009;95:895-899. https://doi.org/10.1136/hrt.2008.155804
- Bangalore S, Fonarow GC, Peterson ED. et al. Age and gender differences in quality of care and outcomes for patients with STEMI. Am J Med 2012;125:1000-1009. https://doi.org/10.1016/j.amjmed.2011.11.016
- Zhang Z, Fang J, Gillespie C. et al. Age-specific gender differences in in-hospital mortality by type of myocardial infarction. Am J Cardiol 2012;109:1097-1103. https://doi.org/10.1016/j.amjcard.2011.12.001
- Rautaharju PM, Mason JW, Akiyama T. New age- and sex-specific criteria for QT prolongation based on rate correction formulas that minimize bias at the upper normal limits. Int J Cardiol 2014;174:535-540. https://doi.org/10.1016/j.ijcard.2014.04.133
- Sinnecker D, Huster KM, Muller A. et al. Sex differences in the noninvasive risk stratification and prognosis after myocardial infarction. J Electrocardiol 2014;47:874-880. https://doi.org/10.1016/j.jelectrocard.2014.08.010
- Priori SG, Blomstrom-Lungqcist C, Mazzanti A. et al. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Eur Heart J 2015;36:2793-2867. https://doi.org/10.1093/eurheartj/ehv316
- Tadros R, Ton AT, Fiset C. et al. Sex differences in cardiac electrophysiology and clinical arrhythmias: epidemiology, therapeutics, and mechanisms. Can J Cardiol 2014;30:783-792. https://doi.org/10.1016/j.cjca.2014.03.032
- Oreel TH, Nieuwkerk PT, Hartog ID. et al. Gender differences in quality of life in coronary artery disease patients with comorbidities undergoing coronary revascularization. PLoS One 2020;15:e0234543. eCollection 2020. https://doi.org/10.1371/journal.pone.0234543
- Madan N, Gajo E, Sanghani RM. et al. Sex-based considerations in the evaluation of chest pain and management of obstructive coronary artery disease. Curr Atheroscler Rep 2020;22:39-45. https://doi.org/10.1007/s11883-020-00855-7
- Sedlak TL, Lee M, Izdnegahdar M. et al. Sex differences in clinical outcomes in patients with stable angina and no obstructive coronary artery disease. Am Heart J 2013;166:36-44. https://doi.org/10.1016/j.ahj.2013.03.015
- Guo Y, Yin F, Fan C. et al. Gender difference in clinical outcomes of the patients with coronary artery disease after percutaneous coronary intervention: A systematic review and meta-analysis. Medicine (Baltimore) 2018;97:e11644. https://doi.org/10.1097/MD.0000000000011644
- Poon S, Goodmann SG, Yan RT. et al. Bridging the gender gap: insights from a contemporary analysis of sex-related differences in the treatment and outcome of patients with acute coronary syndromes. Am Heart J 2012;163:66-73. https://doi.org/10.1016/j.ahj.2011.09.025
- Schulman-Marcus J, Hartaigh BO, Gransar H. et al. Sex specific associations between coronary artery plaque extent and risk of major adverse cardiovascular events: the CONFIRM long-term registry. JACC Cardiovasc Imag 2016;9:364-372. https://doi.org/10.1016/j.jcmg.2016.02.010
- Sato H, Tateishi H, Uchida T. et al. Takotsubo like left ventricular Dysfunction due to Multivessel coronary Spasm. In: Kodama K, Haze K, Hon M. Clinical Aspect of myocardial Injury: from Ischemia to Heart Failure (in Japanese). Tokyo: Kagakuhyouronsya Publishing Co.; 1990:56-64.
- Lyon AL, Bossone E, Schneider B. et al. Current state of knowledge on takotsubo syndrome: a position statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2016;18:8-27. https://doi.org/10.1002/ejhf.424
- Carnlöf C, Iwarzon M, Jensen-Urstad M. et al. Women with PSVT are often misdiagnosed, referred later than men, and have more symptoms after ablation. Scand Cardiovasc J 2017;51:299-307. https://doi.org/10.1080/14017431.2017.1385837
- Zhao M, Woodward M, Vaartjes I. et al. Sex Differences in Cardiovascular Medication Prescription in Primary Care: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020;9:e014742. https://doi.org/10.1161/JAHA.119.014742
- Baigent C, Blackwell L. Antithrombotic Trialists’ (ATT) Collaboration. et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373:1849-1860. https://doi.org/10.1016/S0140-6736(09)60503-1
- Aldiwani H, Mahdai S, Alhatemi G, Bairey Merz CN. Microvascular Angina: Diagnosis and Management. Eur Cardiol. 2021 Dec 2;16:e46. PMID: 34950242; PMCID: PMC8674627. https://doi.org/10.15420/ecr.2021.15
- McDonagh TA, Metra M, Adamo M. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599-3726. https://doi.org/10.1093/eurheartj/ehab368
- Мартынюк ТВ.Идиопатическая легочная гипертензия: клинико-патофизиологичские особенности и возможности патогенетически обоснованной терапии. Автореф.дисс.докт.мед.наук -М.,2013.
- Vonk Noordegraaf A, Westerhof BE, Westerhof N. The Relationship Between the Right Ventricle and its Load in Pulmonary Hypertension. J Am Coll Cardiol 2017;69:236-243. https://doi.org/10.1016/j.jacc.2016.10.047
- Larkin EK, Newman JH, Austin ED. et al. Longitudinal analysis casts doubt on the presence of genetic anticipation in heritable pulmonary arterial hypertension. Am J Respir Crit Care Med 2012;186:892-896. https://doi.org/10.1164/rccm.201205-0886OC
- Chung L, Liu J, Parsons L. et al. Characterization of connective tissue disease-associated pulmonary arterial hypertension from REVEAL: identifying systemic sclerosis as a unique phenotype. Chest 2010;138:1383-1394. https://doi.org/10.1378/chest.10-0260
- Schneider B, Athanasiadis A, Stöllberger C. et al. Gender differences in the manifestation of tako-tsubo cardiomyopathy. Int J Cardiol 2013;166:584-588. https://doi.org/10.1016/j.ijcard.2011.11.027
- Hoeper MM, Humbert M, Souza R. et al. A global view of pulmonary hypertension. Lancet Respir Med 2016;4:306-322. https://doi.org/10.1016/S2213-2600(15)00543-3
- Shapiro S, Traiger GL, Turner M. et al. Sex differences in the diagnosis, treatment, and outcome of patients with pulmonary arterial hypertension enrolled in the registry to evaluate early and long-term pulmonary arterial hypertension disease management. Chest 2012;141:363-373. https://doi.org/10.1378/chest.10-3114
- Patel SM, Chokka RG, Prasad K. et al. Distinctive clinical characteristics according to age and gender in apical ballooning syndrome (takotsubo/stress cardiomyopathy): an analysis focusing on men and young women. J Cardiac Fail 2013;19:306-310. https://doi.org/10.1016/j.cardfail.2013.03.007
- Kjellstrom B, Nisell M, Kylhammar D. et al. Sex-specific differences and survival in patients with idiopathic pulmonary arterial hypertension 2008-2016. ERJ Open Res 2019;5:00075-2019. https://doi.org/10.1183/23120541.00075-2019
- Templin C, Ghadri JR, Diekmann J. et al. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med 2015;373:929-938. https://doi.org/10.1056/NEJMoa1406761
- Murakami T, Yoshikawa T, Maekawa Y. et al. Gender differences in patients with takotsubo cardiomyopathy: multi-center registry from Tokyo CCU Network. PLoS One 2015;10:e0136655. https://doi.org/10.1371/journal.pone.0136655
- Perez-Castellanos A, Martinez-Selles M, Mejia-Renteria H. et al. Tako-tsubo syndrome in men: rare, but with poor prognosis. Rev Esp Cardiol 2018;71:703-708. https://doi.org/10.1016/j.rec.2017.07.021
- Weidner KJ, El-Battrawy I, Behnes M., et al. Sex differences of inhospital outcome and long-term mortality in patients with Takotsubo cardiomyopathy. Ther Clin Risk Manag 2017;13:863-869. https://doi.org/10.2147/TCRM.S131760
- Yoshizawa M, Itoh T, Morino Y., et al. Gender differences in the circadian and seasonal variations in patients with takotsubo syndrome: a multicenter registry at eight university hospitals in east Japan. Intern Med 2021. https://doi.org/10.2169/internalmedicine.6910-20
- Marra AM, Benjamin N, Eichstaedt C. et al. Gender-related differences in pulmonary arterial hypertension targeted drugs administration. Pharmacol Res 2016;114:103-109. https://doi.org/10.1016/j.phrs.2016.10.018
- Gabler NB, French B, Strom BL. et al. Race and sex differences in response to endothelin receptor antagonists for pulmonary arterial hypertension. Chest 2012;141:20-26. https://doi.org/10.1378/chest.11-0404
- Mathai SC, Hassoun PM, Puhan MA. et al. Sex differences in response to tadalafil in pulmonary arterial hypertension. Chest 2015;147:188-197.
- Vogel B, Acevedo M, Appelman Y. et al. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021;397:2385-2438. https://doi.org/10.1016/S0140-6736(21)00684-X
- Lainščak M, Milinković I, Polovina M. et al. Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry. Eur J Heart Fail 2020;22:92-102. https://doi.org/10.1002/ejhf.1645
- Joglar JA, Kapa S, Saarel EV, et al. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm. 2023;20(10):e175-e264. Epub 2023 May 19. PMID: 37211147. https://doi.org/10.1016/j.hrthm.2023.05.017
- Krisai P, Cheniti G, Takagi T, et al. Sex differences in ventricular arrhythmia: epidemiology, pathophysiology and catheter ablation. Rev Cardiovasc Med. 2022 Jan 14;23(1):14. PMID: 35092206. https://doi.org/10.31083/j.rcm2301014
- Sramko M, Abdel-Kafi S, van der Geest RJ, et al. New adjusted cutoffs for “normal” endocardial voltages in patients with post-infarct lv remodeling. JACC Clinical Electrophysiology. 2019; 5: 1115-1126. Tamis-Holland JE, Palazzo A, Stebbins AL. et al. Benefits of direct angioplasty for women and men with acute myocardial infarction: results of the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes Angioplasty (GUSTO II-B) Angioplasty Substudy. Am Heart J 2004;147:133-139. https://doi.org/10.1016/j.ahj.2003.06.002
- Arany Z, Elkayam U: Peripartum Cardiomyopathy. Circulation 2016, 133(14):1397-1409.
- Hilfiker-Kleiner D, Kaminski K, Podewski E, Bonda T, Schaefer A, Sliwa K, Forster O, Quint A, Landmesser U, Doerries C et al.: A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell 2007;128(3):589-600. https:// https://doi.org/doi.org/10.1016/j.cell.2006.12.036
- Damp J, Givertz MM, Semigran M, Alharethi R, Ewald G, Felker GM, Bozkurt B, Boehmer J, Haythe J, Skopicki H et al.: Relaxin-2 and Soluble Flt1 Levels in Peripartum Cardiomyopathy: Results of the Multicenter IPAC Study. JACC Heart Fail 2016;4(5):380-388. https://doi.org/10.1016/j.jchf.2016.01.004
- Ware JS, Li J, Mazaika E, Yasso CM, DeSouza T, Cappola TP, Tsai EJ, Hilfiker-Kleiner D, Kamiya CA, Mazzarotto F et al.: Shared Genetic Predisposition in Peripartum and Dilated Cardiomyopathies. N Engl J Med 2016;374(3):233-241. https://doi.org/10.1056/nejmoa1505517
- Lange S, Auerbach D, McLoughlin P, Perriard E, Schafer BW, Perriard JC, Ehler E: Subcellular targeting of metabolic enzymes to titin in heart muscle may be mediated by DRAL/FHL-2. J Cell Sci 2002;115(Pt 24):4925-4936. https://doi.org/10.1242/jcs.00181
- Lyon AR, Bossone E, Schneider B, Sechtem U, Citro R, Underwood SR, Sheppard MN, Figtree GA, Parodi G, Akashi YJ et al.: Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2016;18(1):8-27. https://doi.org/10.1002/ejhf.424
- Worrall-Carter L, McEvedy S, Wilson A. et al. Gender differences in presentation, coronary intervention and outcome of 28,985 acute coronary syndrome patients in Victoria, Australia. Womens Health Issues 2016;26:14-20. https://doi.org/10.1016/j.whi.2015.09.002
- Tavris D, Shoaibi A, Chen AY. et al. Gender differences in the treatment of NSTEMI. Clin Cardiol 2010;33:99-103. https://doi.org/10.1002/clc.20691
- Tamis-Holland JE, Palazzo A, Stebbins AL. et al. Benefits of direct angioplasty for women and men with acute myocardial infarction: results of the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes Angioplasty (GUSTO II-B) Angioplasty Substudy. Am Heart J 2004;147:133-139. https://doi.org/10.1016/j.ahj.2003.06.002
- Worrall-Carter L, McEvedy S, Wilson A. et al. Gender differences in presentation, coronary intervention and outcome of 28,985 acute coronary syndrome patients in Victoria, Australia. Womens Health Issues 2016;26:14-20. https://doi.org/10.1016/j.whi.2015.09.002
- Tavris D, Shoaibi A, Chen AY. et al. Gender differences in the treatment of NSTEMI. Clin Cardiol 2010;33:99-103. https://doi.org/10.1002/clc.20691
- Kumbhani DJ, Fonarow GC, Cannon CP. et al. Predictors of adherence to performance measures in patients with acute myocardial infarction. Am J Med 2013;126:74.e1-74.e9. https://doi.org/10.1016/j.amjmed.2012.02.025
- Lam CSP, Arnott C, Beale AL. et al. Sex differences in heart failure. Eur Heart J 2019;40:3859-3868c. https://doi.org/10.1093/eurheartj/ehz835
- GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1789-1858. https://doi.org/10.1016/S0140-6736(18)32279-7
- Gukathsan N, Witzenbichler B, Weisz G. et al. Impact of gender on patterns of dual antiplatelet therapy cessation and non adherence. J Am Coll Cardiol 2013;61:e1531. https://doi.org/10.1016/S0735-1097(13)61531-4
- Bangalore S, Makani H, Radford M. et al. Clinical outcomes with beta blockers for myocardial infarction: a meta-analysis of randomized trails. Am J Med 2014;127:939-953. https://doi.org/10.1016/j.amjmed.2014.05.032
- Garg R, Yusuf S. Overview of randomized trials of ACE-I on mortality and morbidity in patients with heart failure. JAMA 1995;273:1450-1456. PMID: 7654275
- Hsu PY, Bittner VA, Betteridge J. et al. Impact of female sex on lipid lowering, clinical outcomes and adverse effects in atorvastatin trials. Am J Cardiol 2015;115:447-453. https://doi.org/10.1016/j.amjcard.2014.11.026
- Asch FM, Miyoshi T, Addetia K. et al. Similarities and Differences in Left Ventricular Size and Function among Races and Nationalities: Results of the World Alliance Societies of Echocardiography Normal Values Study. J Am Soc Echocardiogr 2019;32:1396-1406.e2. https://doi.org/10.1016/j.echo.2019.08.012
- Dewan P, Jackson A, Lam CSP. et al. Interactions between left ventricular ejection fraction, sex and effect of neurohumoral modulators in heart failure. Eur J Heart Fail 2020;22: 898-901. https://doi.org/10.1002/ejhf.1776
- McMurray JJV, Jackson AM, Lam CSP. et al. Effects of SacubitrilValsartan Versus Valsartan in Women Compared With Men With Heart Failure and Preserved Ejection Fraction: Insights From PARAGON-HF. Circulation 2020;141:338-351. https://doi.org/10.1161/CIRCULATIONAHA.119.044491
- Tamargo J, Caballero R, Delpón E. Sex-related differences in the pharmacological treatment of heart failure. Pharmacol Ther 2022;229:107891. https://doi.org/10.1016/j.pharmthera.2021.107891
- Sullivan K, Doumouras BS, Santema BT. et al. Sex-Specific Differences in Heart Failure: Pathophysiology, Risk Factors, Management, and Outcomes. Can J Cardiol 2021;37:560-571. https://doi.org/10.1016/j.cjca.2020.12.025