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Published on: November 18, 2018
Sex differences in pulmonary (arterial) hypertension: does it matter?
Corey E Ventetuolo1,2,3, Alexis E Sherman-Roe1
1Department of Medicine, The Warren Alpert Medical School of Brown University.
Females have higher pulmonary arterial hypertension (PAH) prevalence but better survival and right ventricular (RV) function. This review explores the "sex paradox" in PAH, examining sex chromosomes, hormones, and immune function.
Area of Science:
- Cardiovascular Research
- Pulmonary Medicine
- Sex Differences in Disease
Background:
- Pulmonary arterial hypertension (PAH) exhibits significant sexual dimorphism, with a higher prevalence in females.
- Despite increased prevalence, females with PAH demonstrate better right ventricular (RV) function and improved survival rates, a phenomenon termed the 'sex paradox'.
Purpose of the Study:
- To synthesize current theories explaining the 'sex paradox' in pulmonary arterial hypertension (PAH).
- To review sex differences in other forms of pulmonary hypertension.
- To explore the underlying mechanisms and potential therapeutic targets related to sex biases in pulmonary vascular disease.
Main Methods:
- Comprehensive review of experimental studies and observational human data.
- Analysis of existing literature on sex chromosomes, sex hormones, genomic/epigenetic regulation, and immune function in PAH.
- Examination of sex-based differences in therapeutic responses and social determinants of health.
Main Results:
- Female sex is linked to improved RV function and survival in PAH, despite higher incidence.
- Sex chromosomes, hormones, and epigenetic factors play crucial roles in PAH pathobiology.
- Sex differences are observed in therapeutic responses and outcomes, with ongoing research into sex hormone modulation.
Conclusions:
- The improved survival in females with PAH, despite higher prevalence, remains incompletely understood.
- Recent advancements in understanding sex biases offer promising therapeutic avenues.
- Further research is needed to elucidate mechanisms and identify novel therapeutic targets for pulmonary vascular diseases.
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