Female gender, myocardial remodeling and cardiac failure: are women protected from increased myocardiocyte apoptosis?

Heart failure appears to be less common and less severe in females, and elderly women have a better overall survival after myocardial infarction than males and also a decreased risk of arrhythmic death. Human and animal studies also show that females display more favorable cardiac remodeling in several experimental and clinical conditions. However, the underlying pathophysiologic mechanisms have not been established, even though estrogens, beta-adrenergic stimulation, the renin-angiotensin system, and a greater resistance to myocardiocyte apoptosis in females have been proposed as hypothetical contributing factors. Indeed, epidemiologic, experimental and clinical evidence of gender differences in myocardial remodeling and heart failure favoring women could prompt the use of female myocardial progenitor or stem cells for cellular replacement therapy in cardiac failure, on the premises of a greater protection from myocardial apoptosis and unfavorable remodeling in women.