Gender differences in heart failure: paving the way towards personalized medicine?

Abstract

This editorial refers to ‘The gene expression profile of patients with new-onset heart failure reveals important gender-specific differences’, by B. Heidecker et al. doi:10.1093/eurheartj/ehp549 Patients respond with individual variations to therapeutic approaches. When studying drug effects in pre-clinical research models we are spoiled by a uniform response in the treatment group, often raising hopes about the translation of novel treatment strategies to clinical application. Subsequent clinical studies frequently show, however, that only certain subgroups of patients benefit from our therapy. Knowledge of individual differences in the molecular pathophysiology of a disease might help to optimize treatment strategies in patient groups or even individual patients. Gender, creating the largest two patient subgroups, can influence study results considerably. Naturally, this is of particularly interest in disease entities where aetiology varies. Idiopathic dilated cardiomyopathy (IDCM) is a disease entity which is diagnosed based on clinical parameters and after exclusion of other causes such as ischaemic coronary disease. After initial diagnosis of heart failure due to IDCM, the individual's prognosis varies greatly. Large clinical trials have tried to shed light on differences in the optimal treatment strategy in demographic subgroups. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) has demonstrated ethnic variations in the ideal antihypertensive strategy.1 Next to ethnic diversity, gender differences, which have gained considerable interest in the past years, are often considered to implicate potential imbalances in treatment response. Clinical data are already available on gender-related disparities in outcome after myocardial infarction,2 the progression of myocardial hypertrophy, the clinical course after valve replacement, or ventricular arrhythmias.3 Also in heart failure, differences in aetiology and left ventricular (LV) function between men and women have been described.4 In parallel to these clinical issues, advances in experimental research have made high throughput studies of molecular processes possible. … *Corresponding author. Tel: +49 6841 1623372, Fax: +49 6841 1623369, Email: michael.boehm{at}uniklinikum-saarland.de