Cardiovascular disease is the most common cause of death in men and women worldwide. Men develop most, but not all, cardiovascular diseases at an earlier age while the number of affected women significantly increases with higher age. Heart failure (HF) is a common cause of cardiovascular death and carries a poor prognosis in both genders. Risk factors and myocardial adaptations in HF in men and women are different. Female hearts develop a more favorable physiological form of myocardial remodeling than male hearts. This may be related to sex hormones, estrogens and testosterone. A clinical study for gender differences in human aortic stenosis supports the hypotheses. HF management differs between both sexes, with underdiagnosis and undertreatment and less use of invasive therapies in women. Nevertheless, women frequently have better outcomes than men. Gender research will contribute directly to patient-oriented benefit by suggesting clinical protocols.