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

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.