Sex differences in cardiovascular ageing

Abstract

Despite recent progress in identifying and narrowing the gaps in cardiovascular outcomes between men and women, general understanding of how and why cardiovascular disease presentations differ between the sexes remains limited. Sex-specific patterns of cardiac and vascular ageing play an important role and, in fact, begin very early in life. Differences between the sexes in patterns of age-related cardiac remodelling are associated with the relatively greater prevalence in women than in men of heart failure with preserved ejection fraction. Similarly, sex variation in how vascular structure and function change with ageing contributes to differences between men and women in how coronary artery disease manifests typically or atypically over the adult life course. Both hormonal and non-hormonal factors underlie sex differences in cardiovascular ageing and the development of age-related disease. The midlife withdrawal of endogenous oestrogen appears to augment the age-related increase in cardiovascular risk seen in postmenopausal compared with premenopausal women. However, when compared with intrinsic biological differences between men and women that are present throughout life, this menopausal transition may not be as substantial an actor in determining cardiovascular outcomes.

Increased Cardiac Workload in the Upright Posture in Men: Noninvasive Hemodynamics in Men Versus Women

“…A major predisposing factor to heart failure and stroke is the increased prevalence of hypertension . The withdrawal of estrogen increases the age‐related cardiovascular risk in postmenopausal women, but chronological aging processes acting on top of biological differences between men and women likely play a more important role in the increase of cardiovascular risk …”

“…processes acting on top of biological differences between men and women likely play a more important role in the increase of cardiovascular risk. 63 Another difference between men and women is body height. An inverse association between height and the risk of CVD has been found.…”

Sex, drugs, and heart failure: a sex‐sensitive review of the evidence base behind current heart failure clinical guidelines

“…In addition to differences in HF aetiology, the phenotypic differences in HF presentation and prognosis between women and men may be the result of progressive, sex‐specific changes in cardiac and vascular physiology. This process of ‘CV ageing’ is the end result of years of interaction between traditional risk factors, such as hypertension, and an individual's intrinsic predisposition to develop CV diseases, such as inherited (genetic) factors …”

“…This process of 'CV ageing' is the end result of years of interaction between traditional risk factors, such as hypertension, and an individual's intrinsic predisposition to develop CV diseases, such as inherited (genetic) factors. 23,24 With ageing, the heart progressively develops sex-specific patterns of remodelling. In women, HF aetiology is often hypertension, and women demonstrate greater body-size adjusted increases in LV wall thickness and concentric remodelling than men, which predispose to myocardial stiffness and diastolic dysfunction.…”

Advanced Maternal Age Worsens Postpartum Vascular Function

“…The occurrence of pregnancy complications such as gestational diabetes, preeclampsia, low birth weight infants, and preterm delivery, independently predicts worsened cardiovascular health in women in later years (Catov et al, 2007, 2008; Gongora and Wenger, 2015; Leslie and Briggs, 2016). Further, aging itself, without the added stressor of pregnancy, is known to increase the risk of cardiovascular disease in the general population (Merz and Cheng, 2016; Paolo Emilio et al, 2016). It is likely, therefore, that these risks may accumulate in women of advanced maternal age and cause detrimental cardiovascular outcomes in later life.…”