Преимущественно женские факторы риска при ХСН

Малоподвижный образ жизни является фактором повышенной смертности в женской группе 70-75 лет по сравнению с мужчинами того же возраста. Избыточная масса тела (ИМТ 25.0-29.9) и ожирением ( ИМТ ≥ 30,0) при этом существенно на смертность не влияют (у обоих полов). Body Mass Index and Survival in Men and Women Aged 70 to 75 Flicker L., McCaul K. A., Hankey G J., Jamrozik K., Brown W.J., Byles J.E., Almeida O.P.Journal of the American geriatrics Society; February 2010, 58(2):234–241 http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2009.02677.x/full

У мальчиков чаще, чем у девочек, регистрируется высокое САД по мере приближения к взрослой жизни Emergence of Sex Differences in Prevalence of High Systolic Blood Pressure: Analysis of a Longitudinal Adolescent Cohort .  Circulation, 114(24):2663-70 http://circ.ahajournals.org/cgi/content/abstract/114/24/2663?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Emergence+of+sex+differences+in+prevalence+of+high+systolic+blood+pressure%3A+anal&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

Но у женщин с ХСН чаще регистрируется АГ и средние значения САД и ДАД выше, чем у мужчин У женщин также в среднем ниже уровень клубочковой почечной фильтрации, реже регистрируется ИБС, ниже значения холестерина и триглицеридов, чаще при диабете регистрируется ХСН. Специально для уточнения гендерных и других популяционных особенностей ХСН итальянские специалисты создали реестр GIPSI, с целью сбора данных от сердечной недостаточности населения управляемых врачами общей практики с упором на гендерные различия. У женщин по сравнению с мужчинами с ХСН САД и ДАД были выше, ниже был уровень клубочковой почечной фильтрации, чаще наблюдалась ХСН при диабете. У мужчин чаще обнаруживалась ИБС, гиперхолестеринемия и гипертриглицеридемия. 757 (475 male, 62.7%) 260 general practitioner's practices; 227 patients (143 male, 63.0%) имели явную ХСН (C/D AHA)

G Ital Cardiol (Rome). 2010 Mar;11(3):233-8.
Gender differences of at risk patients with overt heart failure in the real world of general practice. Data from the GIPSI (Gestione Integrata Progetto Scompenso in Italia) registry]
[Article in Italian
Gronda E, Aronica A, Visconti M, Di Malta A, Pini D, Mangiavacchi M, Andreuzzi B, Municinò A, Genovese S, Morenghi E.

U.O. di Cardiologia Clinica, Istituto Clinico Humanitas, IRCCS, Rozzano, MI. edoardo.gronda@multimedica.it

У женщин чаще регистрируется застойная сердечная недостаточность с сохраненной систолической функцией ЛЖ, в целом они старше. Прогноз у них лучше

Ital Heart J. 2002 Nov;3(11):656-64.
Clinical features and prognosis associated with a preserved left ventricular systolic function in a large cohort of congestive heart failure outpatients managed by cardiologists. Data from the Italian Network on Congestive Heart Failure.
Tarantini L, Faggiano P, Senni M, Lucci D, Bertoli D, Porcu M, Opasich C, Tavazzi L, Maggioni AP.

Department of Cardiology, San Martino Hospital, Belluno, Italy.
Abstract
BACKGROUND: The aim of this study was to evaluate the clinical characteristics, 1-year prognosis and therapeutic approach of heart failure with a preserved left ventricular systolic function in a large multicenter registry of patients referred to specialized heart failure clinics. METHODS: The study population consisted of 5164 outpatients (mean age 62 +/- 12 years, 78.8% male, 28.1% in NYHA functional class III-IV) with an available left ventricular ejection fraction (LVEF) measurement at the initial evaluation for enrollment in the Italian Network on Congestive Heart Failure. A 1-year follow-up was available for 2390 patients. RESULTS: 2859 out of 5164 patients (55.4%) had an LVEF < 35%, 1618 (31.3%) had an LVEF between 35 and 45%, and 687 patients (13.3%) had an LVEF > 45%. Patients with an LVEF > 45% were significantly older, more often female and presented a significantly higher prevalence of a hypertensive etiology, obesity and atrial fibrillation. The severity of the clinical picture, as indicated by a lower prevalence of NYHA class III-IV (17.2 vs 35.6%, p = 0.001) and a third heart sound (14.8 vs 33.5%, p = 0.001), was less in patients with an LVEF > 45%. The therapeutic approach differed significantly, with a larger use of calcium antagonists and beta-blockers in patients with an LVEF > 45%, while ACE-inhibitors, diuretics and digoxin were more often prescribed to those with an impaired LVEF. The 1-year mortality and morbidity (all cause and congestive heart failure worsening hospitalizations) were significantly lower in patients with a preserved left ventricular systolic function compared to those with left ventricular systolic dysfunction (8.9 vs 18.8% for mortality, p = 0.001, and 8.3 vs 16.5% for hospital readmissions due to worsening congestive heart failure, p = 0.001, respectively). CONCLUSIONS: Patients with congestive heart failure and a preserved left ventricular systolic function seem to constitute a distinct population not infrequently presenting even in the clinical setting of specialized heart failure clinics. Further studies are needed to establish a definitive and standardized diagnosis and the most appropriate therapy for congestive heart failure with a normal LVEF.