[What do women have in their hearts?].

Heart failure has traditionally been thought of as a typically male problem. However, while women with heart failure have been little represented in clinical trials (0%-32%) and are not so often seen in cardiology units, over half of all patients with this syndrome including over half of those admitted to hospital because of it are women.1 Women with heart failure are usually older than men2; increasing age is not just associated with an increased prevalence of heart failure but with more women patients suffering this problem. Currently over 60% of the mortality associated with heart failure is borne by women, despite their better chances of survival compared to men of the same age (in heart failure age is the foremost prognostic factor). This situation, along with the ever more apparent peculiarities of heart failure in women, has spawned a large number of studies with the aim of redressing the lack of data corresponding to this sex. Studies of patients with systolic heart failure have unanimously shown lower mortality rates among women than among men, with sometimes marked differences in the case of non-ischaemic dilated cardiomyopathy.3 The reasons behind this better prognosis for women are unclear. There is evidence that left ventricular systolic dysfunction has no value as an independent prognostic marker in women. The HOLA study (Heart failure: Observation of Local Admissions) reported the interaction sex-left ventricular ejection fraction (LVEF) to be significant, such that systolic dysfunction in men – but not women – predicts mortality in heart failure.4 It is important to underline here that feminine sex has been associated with a better prognosis in studies of patients with systolic heart failure,5 but that there is no difference between the sexes when heart failure is accompanied by a normal LVEF.6 It is also well known that right What Do Women Have in Their Hearts?