Fig. 1

Central illustration. The biological and environmental factors that associate with the development and progression of LVDD and HFpEF in women and men. In women, a smaller heart size results in higher left ventricular ejection fraction and higher global longitudinal strain [16, 17]. Aging is associated with deterioration of diastolic function in both women and men; hence, female reproductive factors may accelerate diastolic function deterioration [18], but further studies are needed on this topic. It is likely that the loss of estrogens due to the menopausal transition contributes to the progression of HFpEF, but targeted therapeutic options in (post-) menopausal women are not yet available. Traditional cardiovascular risk factors also predispose to HFpEF, and obesity, diabetes, and hypertension are examples of risk factors that are more important in women [19,20,21,22,23,24]. On the other hand, CAD, and the ischemic consequences of CAD, have a larger impact in men with respect to both HFpEF, and HFrEF [25]. Taken together, these biological and environmental factors are likely to explain the susceptibility for HFpEF in women and HFrEF in men but are, inevitably, incomplete