Why Men Fare Worse: Understanding Gender Disparities in Systemic Sclerosis-Associated Pulmonary Hypertension

Area of Science:

• Cardiology
• Rheumatology
• Pulmonology

Background:

• Pulmonary arterial hypertension (PAH) is a severe complication of systemic sclerosis (SSc).
• Male patients with SSc-PAH often exhibit poorer outcomes, yet data on gender differences are limited.
• SSc-PAH affects women more frequently, but men experience worse prognosis.

Purpose of the Study:

• To investigate gender disparities in clinical outcomes for patients with SSc-associated PAH.
• To compare cardiovascular events, right ventricular function, and survival rates between male and female SSc-PAH patients.

Main Methods:

• Retrospective, single-center study of 61 SSc-PAH patients (52 women, 9 men) confirmed by right heart catheterization.
• Analysis of clinical, serological, pulmonary, and echocardiographic data.
• Statistical evaluation of gender differences in cardiovascular events, right ventricular dilation, and survival.

Main Results:

• Male patients showed a significantly higher incidence of cardiovascular events (2.00 vs 1.00, P=.031) and greater prevalence of right ventricular dilation (100% vs 44.23%, P=.002).
• Kaplan-Meier analysis revealed reduced cardiovascular event-free survival (P=.001) and overall survival (P=.014) in men.
• Men had higher mortality (88.89%) than women (57.69%), though not statistically significant (P=.134).

Conclusions:

• Men with SSc-associated PAH experience worse clinical outcomes, characterized by increased cardiovascular events and diminished survival.
• Potential contributing factors include the absence of estrogen's protective effects and testosterone's adverse impact on cardiac remodeling.
• Findings underscore the need for early, gender-specific risk stratification and tailored therapeutic strategies to enhance outcomes in this patient group.