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Sex Differences in Outcomes of Adults With Isolated Coarctation of the Aorta
Alexander C Egbe1, William R Miranda1, C Charles Jain1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
CJC Open
|June 7, 2024
Summary
Women with coarctation of the aorta face higher mortality risks. This may stem from abnormal blood pressure dipping and pulmonary hypertension, warranting further investigation for targeted interventions.
Area of Science:
- Cardiology
- Vascular Medicine
- Sex Differences in Health
Background:
- Limited data exist on sex-based differences in clinical outcomes for adults with coarctation of the aorta (COA).
- Understanding these differences is crucial for personalized risk assessment and management in COA patients.
Purpose of the Study:
- To compare the atherosclerotic cardiovascular disease (ASCVD) risk profile, blood pressure (BP) parameters, echocardiographic findings, and mortality rates between men and women with isolated COA.
Main Methods:
- A retrospective analysis of adult patients with isolated COA treated at Mayo Clinic between 2003 and 2022.
- ASCVD risk factors (hypertension, hyperlipidemia, diabetes, obesity, smoking, CAD) and 24-hour ambulatory BP monitoring were assessed.
- Nocturnal BP dipping patterns and pulmonary artery pressures were analyzed.
Main Results:
- Women with COA exhibited significantly reduced nocturnal BP dipping (P < 0.001) and higher pulmonary artery mean pressure (P = 0.04) and pulmonary vascular resistance index (P = 0.006) compared to men.
- Despite similar ASCVD risk profiles and daytime BP, female sex was independently associated with increased all-cause mortality (aHR 1.26) and cardiovascular mortality (aHR 1.38).
Conclusions:
- Female sex is linked to a higher risk of all-cause and cardiovascular mortality in adults with isolated COA.
- Pulmonary hypertension and abnormal nocturnal BP dipping in women may contribute to these adverse outcomes.
- Further research is needed to elucidate mechanisms and develop targeted strategies for risk mitigation in women with COA.
