HFpEF in women: Five things you should know

Although overall prevalence rates of HF have primarily remained stable over time, there has been a notable increase in HF with preserved ejection fraction. Representing an estimated 50% of HF-related hospitalizations each year, patients with HFpEF also tend to predominantly be women, who outnumber males with the condition by a 2:1 ratio. According to a paper published in Current Opinion in Cardiology, this increase in HFpEF risk among women may be based on “sex-specific maladaptations to hypertensive aging.”

HFpEF is a disease of aging, and is often accompanied by various comorbidities, such as CAD, diabetes, atrial fibrillation, hypertension and obesity. As the population ages and rates of obesity continue to increase, clinicians fear this condition will only become more prevalent.

Currently, there is no proven standard-of-care treatment for HFpEF; instead, doctors utilize consensus guidelines and individualized treatment. As investigators continue to seek potential treatments for HFpEF, clinicians also emphasize prevention of the condition, primarily through avoidance of hypertension and obesity.

Cardiology Today has formulated a list of key facts to know about the prevention and treatment of HFpEF.

1. Long-term treatment with sildenafil does not benefit patients with HFpEF.

The RELAX study evaluated the effects of sildenafil (Viagra, Pfizer and Revatio, Pfizer) in 216 patients with HFpEF, and indicated that after a 24-week regimen, the drug did not improve exercise capacity or quality of life in these patients vs. placebo. Additionally, sildenafil worsened renal function among recipients. However, the researchers concluded that further studies should be conducted in this population. Read more

2. Treatment with spironolactone does not significantly reduce CV events.

According to findings from the TOPCAT study, treatment with spironolactone does not decrease the incidence of CV-related mortality, aborted cardiac arrest or HF-related hospitalization in patients with HFpEF. While patients on spironolactone did have lower rates of HF-related hospitalization than those on placebo, this effect did not achieve statistical significance. Read more

3. In patients with concurrent AF and HFpEF, catheter ablation is a viable treatment for AF.

Patients with HFpEF frequently have left ventricular diastolic dysfunction, which can complicate left atrial remodeling and contribute to the onset of AF. For this reason, it may be more challenging to cure AF without antiarrhythmic drugs among patients with HFpEF than in other populations. A Japanese study evaluated 74 patients with AF and HFpEF who underwent catheter ablation, which yielded a 73% success rate with multiple catheter procedures and medication assistance. Read more

4. Renin-angiotensin system antagonists may decrease mortality among HFpEF patients.

A prospective study of patients enrolled in the Swedish Heart Failure Registry indicated that renin-angiotensin system (RAS) antagonists may reduce mortality among patients with HFpEF. Researchers found that among 16,216 patients with HFpEF, RAS treatment was associated with decreased all-cause mortality. Read more

5. Angina pectoris and HFpEF is a dangerous combination.

Although HFpEF patients often have multiple comorbidities, angina pectoris seems to be especially predictive of major adverse CV events. A study conducted at Duke University Medical Center included 3,517 patients with HFpEF who underwent coronary angiography, 40% of whom also had angina pectoris. The researchers found that those with both HFpEF and angina pectoris were at increased risk for the primary endpoint, a composite of death, MI, revascularization and stroke. Read more