Gender Differences in the Clinical and Metabolic Manifestations of Anemia in Chronic Heart Failure

Background/Objectives: Anemia and abnormalities in iron-related biomarkers are common in chronic heart failure (CHF), but their relationships with biological sex and left ventricular ejection fraction (LVEF) remain incompletely understood. This study assessed sex-related differences in hematological, iron-related, oxidative stress, and purine metabolism biomarkers across CHF phenotypes.

Methods

This cross-sectional observational study included 180 patients with CHF, classified according to sex, anemia status based on World Health Organization sex-specific hemoglobin thresholds, and LVEF category: heart failure with preserved ejection fraction (HFpEF), mildly reduced ejection fraction (HFmrEF), or reduced ejection fraction (HFrEF). Hematological parameters, serum iron, ferritin, plasma and erythrocyte purine metabolites, oxidative modification of proteins (OMB), and advanced oxidation protein products (AOPPs) were evaluated. Group comparisons were performed using the Kruskal–Wallis and Mann–Whitney U tests, with Benjamini–Hochberg false discovery rate correction for multiple testing.