Erin Michos, MD: HFpEF in Women and Sex-Specific Therapeutic Approaches

In this expert interview, Erin Michos, MD, director of women's cardiovascular health and the associate director of preventive cardiology within the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease discussed the prevalence, risk factors, and management of heart failure with preserved ejection fraction (HFpEF) in women, highlighting critical differences compared to men.

Women exhibit a higher prevalence of HFpEF, with unique contributors such as hypertensive disorders of pregnancy, infertility, and distinct cardiac remodeling patterns that predispose them to diastolic dysfunction. While women with HFpEF report a greater symptom burden and poorer quality of life, they tend to have better hard outcomes, such as lower rates of cardiovascular death and heart failure hospitalization, compared with men.

At the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC), Michos underscored that recent clinical trials, including DELIVER, EMPEROR-Preserved, and FINE-HEARTS, demonstrate that modern therapies like SGLT2 inhibitors, nonsteroidal MRAs, and incretin-based treatments are equally effective for men and women with HFpEF. However, real-world data revealed a significant underutilization of these therapies in women, perpetuating a gap in care. Although GLP-1 receptor agonists show greater weight loss in women, their clinical benefits, including improvements in quality of life and cardiovascular outcomes, are consistent across sexes, supporting their use in all HFpEF patients regardless of gender.

The conversation also highlighted the challenges of diagnosing HFpEF, particularly in women, whose symptoms are often attributed to comorbidities like obesity rather than the condition itself. Dr. Michos advocated for the use of diagnostic tools such as the H2FPEF score to improve recognition and stressed the importance of addressing systemic biases that hinder equitable treatment. She called for heightened awareness and proactive management to leverage the growing arsenal of effective therapies, ultimately improving outcomes for all patients with HFpEF.

Disclosures: Relevant disclosures for Erin Michos, MD include Arrowhead, Bayer, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, and others.

References

Michos E. HFpEF in Women and Sex-Specific Response to Therapies. Presented at World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC) 2024. Los Angeles, California. December 12-14, 2024.