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Cardiovascular diseases in pregnancy are increasing, and account for the majority of pregnancy-induced maternal deaths. Among them, hypertensive disorders are most frequent affecting 6-8% of all pregnancies.
More severe forms like preeclampsia and HELLP syndrome represent serious complication and were associated with far-reaching consequences for mother and child such as stillbirth, peripartum cardiomyopathy, diastolic heart failure and a longterm increased risk for cardiovascular disease. While risk factors such as obesity, smoking, diabetes, twin pregnancy, multiparity, advanced age of the mother, in vitro fertilization are well known, the pathophysiology remains poorly understood). As a consequence, specific treatment options are limited, also in part due to the challenge to perform clinical trials in pregnant women.
The present review provides an overview of the current state of knowledge and summarizes treatment strategies and therapy options.
The prevalence of heart failure (HF) is increasing, mainly due to population aging. There are important biological (sex) and sociocultural (gender) differences in epidemiology, pathophysiology, phenotype, prognosis, and treatment of HF between women and men. While the overall lifetime risk of HF is similar between men and women, women with HF are older, have more comorbidities, and a higher incidence of heart failure with preserved ejection fraction (HFpEF) than men. Men instead present a predisposition to the development of heart failure with reduced ejection fraction (HFrEF) due to their higher incidence of coronary artery disease. Sex differences are also notable in the penetrance of genetic cardiomyopathies, HF risk factors as well as in sex-specific conditions such as peripartum cardiomyopathy (PPCM), cancer treatment-induced cardiomyopathy, and Takotsubo cardiomyopathy. Although women with HF have a better age-adjusted prognosis than men, they experience worse quality of life. Underpinning current sex disparities in HF, HF treatment is limited by a profound underrepresentation of women in clinical trials, which has resulted in a lesser understanding of disease behaviour in female patients and in treatment guidelines that are predominantly based on male-derived data. In addition, a full understanding of the impact of sociocultural gender on HF management and disease course is lacking. This review outlines the key sex differences with respect to clinical characteristics, pathophysiology, and therapeutic responses to HF treatments. Finally, we address existing knowledge gaps in sex-specific mechanisms, optimal drug doses for women and sex-specific criteria for device therapy and heart transplantation.
The influence of sex – considered to be the biological differences between women and men – and gender – considered to be sociologically constructed differences based on membership in one of the two sex categories – appears to be particularly important for noncommunicable diseases such as type 2 diabetes (T2D) and obesity. Many T2D risk factors are behavioral and greatly, but not only, influenced by gender-related determinants, making them modifiable factors. In this review, we focus on sex-related biological differences in the prevalence of diabetes and its biological risk factors, such as obesity, fat distribution, metabolic syndrome, and glucose homeostasis, with a particular interest in the influence of menopause and pregnancy. Men have had globally a higher prevalence of T2D than women with regional, socioeconomic, and age-related variations. Overall, women tend to be more protected from cardiometabolic diseases before menopause than men. However, hormonal variation during the course of life, particularly during menopause, modifies these risks. Similarly to T2D, there are differences in the prevalence of obesity between women and men that change during the lifespan. The link between obesity and T2D seems to be stronger in women compared to men. Various hormones can impact on glycemic levels and on body fat and their concentrations and effect on metabolic parameters can differ by sex. Understanding and acknowledging sex-related differences in T2DM and its risk factors is important to improve health research and lead to better clinical care and more suitable preventive policies and programs for both women and men.
With the continuous improvement of therapies against breast cancer, the long-term onset of cardiovascular disease (CVD) is becoming increasingly relevant for both cardiologists and oncologists. Not only CVD arises from known cardiac side effects of several anti-cancer therapies, but cancer itself seems to promote CVD. On the other hand, there is increasing evidence that CVD such as myocardial infarction and heart failure predispose to future development of cancer. The fast-developing field of cardio-oncology aims to characterize cancer patients in order to implement effective tools for surveillance and prevention of cardiovascular adverse events and to raise awareness for the increased cancer incidence in patients with CVD. The aim of this review is to highlight cardiovascular side effects and toxicities of some of the most important breast cancer therapies and to provide an overview of what is known on the complex interplay between CVD and breast cancer.
