The Female Athlete’s Heart: Facts and Fallacies

Abstract

Purpose of the reviewFor many years, competitive sport has been dominated by men. Recent times have witnessed a significant increase in women participating in elite sports. As most studies investigated male athletes, with few reports on female counterparts, it is crucial to have a better understanding on physiological cardiac adaptation to exercise in female athletes, to distinguish normal phenotypes from potentially fatal cardiac diseases. This review reports on cardiac adaptation to exercise in females.Recent findingsRecent studies show that electrical, structural, and functional cardiac changes due to physiological adaptation to exercise differ in male and female athletes. Women tend to exhibit eccentric hypertrophy, and while concentric hypertrophy or concentric remodeling may be a normal finding in male athletes, it should be evaluated carefully in female athletes as it may be a sign of pathology. Although few studies on veteran female athletes are available, women seem to be affected by atrial fibrillation, coronary atherosclerosis, and myocardial fibrosis less than male counterparts.SummaryMales and females exhibit many biological, anatomical, and hormonal differences, and cardiac adaptation to exercise is no exception. The increasing participation of women in sports should stimulate the scientific community to develop large, longitudinal studies aimed at a better understanding of cardiac adaptation to exercise in female athletes.

Balanced Intense Exercise Training Induces Atrial Oxidative Stress Counterbalanced by the Antioxidant System and Atrial Hypertrophy That Is Not Associated with Pathological Remodeling or Arrhythmogenicity

“…A characteristic, coherent distinction was observed regarding fibrosis and profibrotic factors: both control and exercised female rats showed significantly decreased collagen area and lower expression of TGFβ and MMP2 ( Figure 3 ). This is in line with previous observations, where women seem to be affected by atrial fibrillation, coronary atherosclerosis, and myocardial fibrosis less than male counterparts [ 39 ]. Indeed, there is evidence that estrogen receptors play a role in the regulation of collagen expression of cardiac fibroblasts [ 40 ].…”

Sudden Cardiac Death in Sports: Why Its Prevalence is So Different by Gender?

“…A recent review reported some mechanisms of cardiac remodelling and highlighted that hormones and genes may play a role in this process. 19 Some studies have shown the presence of androgenic and estrogenic receptors in myocytes and the hormonal effects on myocardial response. Whereas testosterone stimulates myocardial hypertrophy, estrogens inhibit the proliferation of cardiac fibroblasts.…”

The Underrepresentation of Females in Studies Assessing the Impact of High-Dose Exercise on Cardiovascular Outcomes: a Scoping Review

“…There is evidence to suggest female cardiac adaptations may differ from those seen in their male counterparts. For example, females may be more likely to undergo concentric remodelling [ 20 , 21 ]. Studies that have demonstrated myocardial fibrosis have observed these adaptions only in their male participants [ 11 , 22 ].…”

“…There is evidence to suggest female cardiac adaptations may differ from those seen in their male counterparts. For example, females may be more likely to undergo concentric remodelling [20,21].…”