There is a type of heart failure that affects women far more often than men, yet many people have never heard of it. It is called Heart Failure with Preserved Ejection Fraction, also known as HFpEF.
What makes HFpEF confusing is that the heart may still appear to pump normally. Some test results may even look “fine.” But the person may still feel short of breath, exhausted, and unable to do normal daily activities. Too often, these symptoms are dismissed as anxiety or aging.
The problem in HFpEF is not how the heart squeezes. The problem is how the heart relaxes. When the heart becomes stiff, it cannot fill properly between beats. As pressure builds up inside the heart and lungs, symptoms like breathlessness, fatigue, and exercise intolerance can appear, even when the pumping function looks normal.
Women make up more than half of all HFpEF cases. Despite this, they are often diagnosed later and may receive less aggressive treatment. This makes HFpEF not just a heart condition, but also a major diagnostic gap in women’s health.Several risk factors may affect women’s hearts differently. High blood pressure, obesity, and diabetes can all increase the risk of HFpEF. Diabetes is especially important. It raises the risk of heart failure much more strongly in women than in men.
Hormonal changes may also play a role. After menopause, estrogen levels decline. This can increase inflammation, stiffen blood vessels, and raise the risk of heart failure. Pregnancy history matters too. Women who have had preeclampsia may have a higher risk of developing heart failure later in life, sometimes decades after pregnancy.
What is especially concerning is that women with HFpEF may live longer with the condition but experience worse symptoms and lower quality of life. Some treatments may work particularly well in women, but women are still underrepresented in many clinical trials. Because of this, we still do not fully understand how HFpEF behaves differently in women and men.
So, if you have a history of high blood pressure, diabetes, obesity, menopause-related symptoms, or preeclampsia, it is important to pay attention to your heart health.
Shortness of breath should not be ignored. Fatigue should not always be brushed off. And women deserve to have their symptoms taken seriously. HFpEF is common, often missed, and especially important in women’s health. The more we talk about it, the earlier it can be recognized.
