Sex differences in pressure and flow waveform physiology across the life course

Abstract

Cardiovascular disease (CVD) has long been deemed a disease of old men. However, in 2019 CVD accounted for 35% of all deaths in women and, therefore, remains the leading cause of death in both men and women. There is increasing evidence to show that risk factors, pathophysiology and health outcomes related to CVD differ in women compared with men, yet CVD in women remains understudied, underdiagnosed and undertreated. Differences exist between the sexes in relation to the structure of the heart and vasculature, which translate into differences in blood pressure and flow waveform physiology. These physiological differences between women and men may represent an important explanatory factor contributing to the sex disparity in CVD presentation and outcomes but remain understudied. In this review we aim to describe sex differences in arterial pressure and flow waveform physiology and explore how they may contribute to differences in CVD in women compared to men. Given that unfavourable alterations in the cardiovascular structure and function can start as early as in utero, we report sex differences in waveform physiology across the entire life course.

Arterial Hypertension in Women: State of the Art and Knowledge Gaps

“…A higher heart rate, lower cardiovascular contractility, and earlier reflected arterial pulse waves with augmentation of central systolic rather than diastolic blood pressure are thought to result in lower brachial and central diastolic blood pressures and more microvascular damage than in men. 9,17,29–31 Sex differences in autonomic neuronal hemodynamic regulation are understudied. 9,17,29,31…”

“…9,17,[29][30][31] Sex differences in autonomic neuronal hemodynamic regulation are understudied. 9,17,29,31 Estrogens are cardioprotective, reduce cardiomyocyte oxidative, ischemic, and hypertensive stress and promote vasodilation in the peripheral vasculature and coronary arteries while inhibiting the development of atherosclerosis. 32,33 However, in older women and pharmacological doses, estrogen might have adverse effects on the vessel wall.…”

“…A higher heart rate, lower cardiovascular contractility, and earlier reflected arterial pulse waves with augmentation of central systolic rather than diastolic blood pressure are thought to result in lower brachial and central diastolic blood pressures and more microvascular damage than in men. 9,17,[29][30][31] Sex differences in autonomic neuronal hemodynamic regulation are understudied. 9,17,29,31 Estrogens are cardioprotective, reduce cardiomyocyte oxidative, ischemic, and hypertensive stress and promote vasodilation in the peripheral vasculature and coronary arteries while inhibiting the development of atherosclerosis.…”

“…9,17,29–31 Sex differences in autonomic neuronal hemodynamic regulation are understudied. 9,17,29,31…”

Russian eligibility criteria prescribing menopausal hormonal hormones therapy for patients with cardiovascular and metabolic diseases. Consensus document of the Russian Cardiological Society, Russian Society of Obstetricians and Gynecologists, Russian Association of Endocrinologists, Eurasian Association of Therapists, Association of Phlebologists of Russia

“…Выделяют следующие специфичные для женщин патофизиологические характеристики АГ [95] В постменопаузе у женщин наблюдается более быстрое (по сравнению с мужчинами такого же возраста) увеличение артериальной жесткости. У женщин пожилого возраста отмечается более высокая ригидность аорты, чем у мужчин, что, по-видимому, способствует развитию изолированной систолической АГ, неконтролируемой АГ, сердечной недостаточности с сохраненной фракцией выброса левого желудочка, аортальному стенозу, что чаще встречается у женщин [96,97].…”