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Gender and heart failure: a population perspective
  1. P A Mehta,
  2. M R Cowie
  1. Clinical Cardiology, National Heart & Lung Institute, Imperial College, London, UK
  1. Correspondence to:
    Professor Martin R Cowie
    Clinical Cardiology, National Heart & Lung Institute, Imperial College, London SW3 6LY, UK; m.cowie{at}

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Randomised clinical trials of drug treatment for chronic heart failure are the basis of many physicians’ beliefs about heart failure. Due to the selection bias of such studies—which preferentially recruit relatively young white men with coronary artery disease—relatively little attention has focused on gender differences in heart failure. This article provides an overview of such gender differences, based on population-based studies in North America and Europe.


It is difficult to make comparisons between prevalence studies (and across time) due to differences in the case definitions employed.1 There is no “gold standard” for heart failure, and most recent studies rely heavily on echocardiography to demonstrate underlying cardiac abnormalities in patients with symptoms that might be caused by heart failure. Most studies rely on administering questionnaires regarding symptoms, a few collect information on clinical signs, and very few combine robust clinical assessment with echocardiographic data. The prevalence of left ventricular systolic dysfunction is relatively straightforward, if time consuming, to establish within a population; however, this is not synonymous with heart failure.

The Framingham heart study, a large cohort study from Massachusetts in the United States, reported an estimated prevalence of heart failure of 0.8% in both genders within the age group of 50–59 years. The prevalence increases notably with advancing age, rising to 6.6% and 7.9% in men and women, respectively, aged 80–89 years.2 The US National Health And Nutrition Examination Survey (NHANES) study reported an overall prevalence of approximately 2% in both men and women aged 25–74 years, based on a clinical score system derived from the Framingham heart study.3

European data suggest a similar prevalence of heart failure of between 1–2%.4,5 In the UK, there have been two major population based echocardiographic studies of heart failure prevalence. The 1992 MONICA (monitoring trends and determinants in …

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