SEX DIFFERENCES IN CARDIOVASCULAR DISEASE


Vera Regitz-Zagrosek, M.D., Center for Cardiovascular Research, Berlin, Germany

Sex differences affect the presentation, treatment results, and outcomes of cardiovascular diseases. Men suffer at younger ages than women from coronary artery disease and hypertension and more commonly develop systolic heart failure or aortic aneurysms. Women are more frequently affected by heart failure with preserved ejection fraction, long QT-syndromes and Tako-tsubo cardiomyopathy. They exhibit a more favorable remodeling under pressure overload and a better survival with heart failure. Even within the same clinical syndromes of myocardial infarction, hypertension, or heart failure, sex differences exist in pathophysiological mechanisms, in the development of myocardial hypertrophy, fibrosis, inflammation, and vascular remodeling. As a result, male or female sex is characterized by specific manifestations of organ damage. In several animal models of myocardial infarction, vascular disease, myocardial hypertrophy, or heart failure, females have better outcomes than males. Sex differences arise at the molecular and cellular level from the control of gene transcription, intracellular signaling, organelle function, and crosstalk between heart, skeletal muscle, adipose tissue, and the immune system. A better understanding of sex differences in cardiovascular pathophysiology will facilitate identifying targets that respond to specific therapies and subsequently could lead towards a more individualized medicine. At present, the development of new cardiovascular drugs has reached a plateau after years of continuous progress. An improved understanding of sex-specific disease mechanisms, therapeutic targets, and target groups will ameliorate this situation towards more efficient treatments of both women and men.