Sex Difference in Cardiovascular Risk

Abstract

Objectives Our aim was to explore whether the carotid/brachial pulse pressure (C/B-PP) ratio selectively predicts the gender difference in age-related cardiovascular death. Background Hypertension and cardiovascular complications are more severe in men and post-menopausal women than in pre-menopausal women. C-PP is lower than B-PP, and the C/B-PP ratio is a physiological marker of PP amplification between C and B arteries which tends toward 1.0 with age. Methods The study involved 72,437 men (aged 41.0±11.1 years, mean±SD) and 52,714 women (39.5±11.6 years). C-PP was calculated for each gender by a multiple regression analysis including B-PP, age, height and risk factors, a method validated beforehand in a subgroup of 834 subjects. During the 12 years of follow-up, 3028 men and 969 women died. Results In the total population, the adjusted hazard ratios (HR, 95% CI) of C/B-PP ratio were: (i) for all cause mortality: men, 1.51 (1.47–1.56), women, 2.46 (2.27–2.67) (p<0.0001); (ii) for cardiovascular mortality: men, 1.81 (1.70–1.93), women, 4.46 (3.66–5.45) (p<0.0001). The C/B-PP impact on mortality did not significantly increase from younger men to those over 55, from: 1.44 (1.31–1.58) to 1.65 (1.48–1.84), but increased significantly with age in women: 3.19 (2.08–4.89) vs 5.60 (4.17–7.50) (p<0.01). Thus the mortality impact of C/B-PP ratio was 3-fold higher in women than in men over 55. Conclusions The C/B amplification is highly predictive of differences in cardiovascular risk between men and women. In post-menopausal women, the attenuation of PP amplification, mainly related to increased aortic stiffness, contributes to the significant increase in cardiovascular risk.

Correlation between Proximal Abdominal Aortic Stiffness Measured by Ultrasound and Brachial-Ankle Pulse Wave Velocity

“…The higher pulse pressure in females is likely to be the reason for those differences. It is known that pulse pressure tends to be higher in females than males after the age of 50 29). In addition, we found that diastolic aortic dimensions were significantly lower among female subjects, which is consistent with a previous study suggesting that aortic arch diameter in the diastole was lower in females than in males (2.56±0.31 mm vs. 2.88±0.35 mm) 30).…”

Sex Differences in Predictors of Longitudinal Changes in Carotid Artery Stiffness

“…Though we did not observe a significant association between menopause and stiffness progression in women, other studies have found that for post-menopausal women, the loss of estrogenic activity in arterial walls contributes to decreased elasticity and rapid stiffening. 21 The rate of decline in DC was most dramatic for both sexes between ages 75-84 years and was significant compared to each other decade within each sex. Among those aged >75 years, the rate of change in DC and YEM may have been blunted by floor and ceiling effects, meaning that there was minimal physiological capacity to stiffen more among the oldest participants with the most advanced degree of stiffening.…”

“…Age-related increases in CVD morbidity and mortality may reflect hormonal changes following the menopausal transition leading to a higher incidence of systolic hypertension and rapid arterial stiffening in women, though we were not able to identify an effect of menopause in our analyses. 21,22 Sex differences in preventive treatments also have been described among older women with prior history of myocardial infarction, who were less likely to receive lipid-lowering medication following an event and were less frequently treated with aspirin, beta-blockers or thrombolytic therapy during an acute event coronary syndrome. 23,24 …”

“…Women in the oldest age category had the stiffest vessels at baseline, but experienced a similar rate in progression as men over the decade. The advanced stiffness in the oldest women at baseline may reflect higher prevalence of systolic hypertension 21,28 or impaired remodeling due to genetic or hormonal differences. Though we did not observe a significant association between menopause and stiffness progression in women, other studies have found that for post-menopausal women, the loss of estrogenic activity in arterial walls contributes to decreased elasticity and rapid stiffening.…”

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

“…Obesity was reported in 34% of the Irbesartan in Heart Failure With Preserved Ejection Fraction (I‐PRESERVE) trial and in 40% of patients who, undergoing coronary angiography at the Mayo clinic, were found to have LV remodeling and diastolic dysfunction without obstructive epicardial CAD 102, 103. Sex‐related increase in LVH and proximal aortic stiffness with altered ventricular‐arterial coupling partly accounts for the preponderance of women in HFpEF 63, 104, 105, 106, 107…”