Sex differences in arterial stiffness and ventricular-arterial interactions

Area of Science:

• Cardiovascular Physiology
• Vascular Biology
• Sex Differences in Health

Background:

• Heart failure with preserved ejection fraction (HFpEF) is more common in women.
• The underlying reasons for this sex disparity in HFpEF remain incompletely understood.
• Ventricular-arterial interactions are critical in cardiovascular health and disease.

Purpose of the Study:

• To investigate sex-based differences in arterial stiffness and ventricular-arterial interactions.
• To determine if arterial parameters are associated with diastolic dysfunction and ventricular-arterial coupling differently in men and women.
• To explore potential mechanisms contributing to the higher HFpEF prevalence in women.

Main Methods:

• Echocardiography and arterial tonometry were used in 461 participants without heart failure.
• Quantified aortic characteristic impedance (Zc), total arterial compliance, and systemic vascular resistance index.
• Performed sex-specific regression analyses to link arterial parameters with diastolic dysfunction and ventricular-arterial coupling (Ea/Ees).

Main Results:

• Women had higher Zc and lower arterial compliance than men; systemic vascular resistance index was similar.
• In women only, higher Zc and lower arterial compliance were significantly associated with diastolic dysfunction and altered ventricular-arterial coupling (Ea/Ees).
• Systemic vascular resistance index showed no association with diastolic dysfunction or Ea/Ees in either sex.

Conclusions:

• Women exhibit greater proximal aortic stiffness (Zc) and pulsatile arterial load compared to men.
• Women appear more vulnerable to the adverse effects of arterial stiffness on diastolic function and ventricular-arterial interaction.
• These sex-specific vascular alterations may contribute to the increased risk of HFpEF in women.