Vascular Function in Women with Heart Failure with Preserved Ejection Fraction: A Mismatch Beyond Diastole

Heart failure with preserved ejection fraction (HFpEF) is a complex multi-organ clinical syndrome representing ~50% of all heart failure related cases nationwide. HFpEF is more prevalent in women yet both men and women with HFpEF present with distinct clinical phenotypes and prognosis that may be attributable, in part, to sex differences in anatomical, physiological, and/or hormonal characteristics. Of particular interest is the role of sex hormones, namely estrogen, as a contributing factor to sex differences in vascular health in patients with HFpEF. This mini review provides a summary of recent evidence regarding sex differences in coronary microvascular function, peripheral vascular function, and central arterial stiffness in patients with HFpEF. Focus will also be given to potential mechanisms by which age-related loss of estrogen may alter these aspects of physiology in women with HFpEF and provide potential future directions related to implications for women's health in adults with HFpEF.