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Sex Differences in Age-Associated Concentric Remodeling and Diastolic Dysfunction.

Israel Gotsman1, Donna R Zwas1, Andre Keren1

  • 1Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.

JACC. Advances
|April 2, 2026
PubMed
Summary
This summary is machine-generated.

Sex differences in cardiac aging emerge after age 60, with females showing increased remodeling and diastolic dysfunction independent of comorbidities. This highlights the need for sex-specific heart failure prevention strategies.

Keywords:
agingdiastolic functionechocardiographysex

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Area of Science:

  • Cardiology
  • Gerontology
  • Cardiovascular Aging

Background:

  • Diastolic dysfunction is key in heart failure with preserved ejection fraction.
  • Age, sex, and risk factors influence diastolic dysfunction.
  • Understanding sex-specific cardiac aging is crucial.

Purpose of the Study:

  • Determine the age of onset for sex-related diastolic function disparities.
  • Establish intrinsic sex differences in cardiac aging.
  • Inform sex-specific prevention strategies for heart failure.

Main Methods:

  • Analyzed echocardiographic parameters in 42,077 individuals (18,476 females, 23,601 males).
  • Used covariate-adjusted general linear models to assess age-by-sex interactions.
  • Performed sensitivity analysis on a comorbidity-free subgroup (N = 14,250).

Main Results:

  • Significant age-by-sex interactions found for all parameters (P < 0.001).
  • Females showed increased septal thickening, reduced LV diameter, and concentric remodeling after age 60.
  • Diastolic function declined in females from the sixth decade (decreased e', increased E/e').
  • Older females had larger left atrial volume index and higher TR gradients.
  • Sex-specific disparities in diastolic function emerged around age 60, persisting in the comorbidity-free subgroup.

Conclusions:

  • Age-associated cardiac remodeling and diastolic dysfunction in older females are independent of comorbidities.
  • Findings support intrinsic, sex-specific differences in cardiac aging, particularly after menopause.
  • Results advocate for tailored, sex-specific prevention and treatment strategies for cardiovascular diseases.