Cardiovascular diseases are the leading causes of death in men and women in industrialized countries. While the effects of biological sex on cardiovascular pathophysiology have long been known, the sex-specific mechanisms mediating these processes have been further elucidated over recent years. This review aims at analysing the sex-based differences in cardiac structure and function in adult mammals, and the sex-based differences in the main molecular mechanisms involved in the response of the heart to pathological situations. It emerged from this review that the sex-based difference is a variable that should be dealt with, not only in basic science or clinical research, but also with regards to therapeutic approaches.
LINKED ARTICLESThis article is part of a themed section on Biological Sex and Cardiovascular Pharmacology. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2014.171.issue-3 Abbreviations AR, androgen receptor; CVD, cardiovascular disease; DOCA, deoxycorticosterone acetate; E-C, excitation-contraction; ET-1, endothelin-1; ER, oestrogen receptor; HRT, hormone replacement therapy; LV, left ventricular; MI, myocardial infarction; NP, natriuretic peptide; PCH, pathological cardiac hypertrophy; PR, progesterone receptor; RAAS, renin-angiotensin-aldosterone system; SERCA, sarco/endoplasmic reticulum Ca 2+ -ATPase; TAC, thoracic aorta constriction; VSMC, vascular smooth muscle cell
IntroductionCardiovascular diseases (CVDs) are the leading cause of death in men and women in industrialized countries. Over the last decade, while little change was noticed on the sex ratio of cohorts in the majority of CVD studies (Mosca et al., 2011), several clinical trials provided evidence that sex is an important determinant of cardiovascular events in patients with vascular diseases or high-risk diabetes mellitus. Indeed, female diabetic patients had a higher risk for acute myocardial infarction compared to male diabetics (Kappert et al., 2012). Women also exhibited a marked increase in the incidence of left ventricular (LV) hypertrophy after the menopause, when the prevalence of arterial hypertension increases (Lopez-Ruiz et al., 2008). Furthermore, women generally display better cardiac function and survival in the face of CVD than men, although this advantage is lost when comparing postmenopausal women with age-matched men (Fujimoto et al., 2013).The effects of biological sex on cardiovascular physiology or pathology have long been known, but the biological mechanisms responsible for sex-related differences started to be unravelled over the last decades. Indeed, sex steroid hormones (oestrogens in female, testosterone in male) contribute significantly to the sex-based differences in the outcome of cardiac diseases, although the contribution of environmental oestrogen-like molecules, such as phytoestrogens, must not be neglected. Thus, hormonal therapy such as the hormone replacement therapy (HRT) after menopause using synthetic oestrogens and progesterone, while broadly debated, may help...