Women are Prone to Age-Related aortic Stiffness

Abstract

Background The morphology of the aorta changes with age, our study aims to investigate sex differences in the aortic aging by analyzing aortic diameter and tortuosity in different segments of aorta across the age spectrum, using enhanced CT imaging. Methods Between July 2021 and April 2022, a retrospective study screened patients with chest and abdomen contrast CT images. The outer edge-to-outer edge method was utilized to measure aortic diameters at five aortic levels, while arterial tortuosity of various segments was measured and calculated using imaging software. Mean values were compared at different age groups, including by sex, and correlation with age was determined. To validate the coherence of arterial elasticity and anticipated age-related arterial alterations, a subset of data from a previously published article in BMJ Open was extracted for the purpose of examining the correlation between age and arterial stiffness, stratified by sexes. Results 208 participants (56.6% men, mean age 60.13±16.33 years old, mean BMI 23.07±4.03 kg/m2, mean BSA 1.70±0.19 m2) were enrolled in this study. The BSA-adjusted aortic diameters showed a positive correlation with age in both sexes, but females demonstrated a more rapid increase in progressive aortic diameters throughout their lifespan than males. In the age groups of 60-69 and above 80 years old, males exhibited significantly larger L1 measurements than females. Conversely, in individuals over 80 years old, females displayed greater L3 values compared to their male counterparts. However, no sexual disparities were observed for L2, L4 and L5 across all ages. Females exhibited greater aortic tortuosity in the descending thoracic region compared to males across all age groups, whereas this sex-based distribution of aortic and abdominal tortuosity was only evident among individuals over 40 years old. The tortuosity of the aorta and descending thoracic aorta exhibits a marked increase with advancing age, particularly in females, while a non-significant linear correlation is observed between abdominal aortic tortuosity and age in both genders. BaPWV consistently increased with age in both males and females, but the increase was more significant in females. Although males initially had higher arterial stiffness, females surpassed them as they aged. Conclusions Patterns of vascular aging in aortic morphology differ between the sexes across the life course, with women experiencing more significant changes, especially in advanced age groups.