New evidence supports a gender-related difference in the rate of vascular aging, previously understood as a delayed emergence of cardiovascular disease in women. Researchers report that persistent blood-pressure (BP) changes, which are often the earliest indicator of physiologic cardiovascular changes, are observed earlier in female patients. Current research published January 2020 in JAMA Cardiology is sparking debate over sex differences in BP trajectories over time and what this finding could mean in the fight against cardiovascular disease, as well as prevention.
According to senior author Susan Cheng, MD, MPH, MSc, director of public health Research at the Smidt Heart Institute at the Cedars-Sinai Medical Center in Los Angeles, sex does matter. Dr. Cheng and her team set out to explore the meaning of sex-based differences in what they describe as early onset, sex-driven dimorphism. The scientists surmise this is why women might be more likely to develop specific patterns of cardiovascular disease at different stages of life.
“Our data showed that rates of accelerating blood pressure elevation were significantly higher in women than men, starting earlier in life,” said Dr. Cheng, adding, “This means that if we define the hypertension threshold the exact same way, a 30-year old woman with high blood pressure is probably at higher risk for cardiovascular disease than a man with high blood pressure at the same age.”
The researchers analyzed nearly 33,000 individuals, slightly more than half of whom were females (54%). The total population ranged from age 5 years to age 98 years. In addition to age, researchers examined systolic and diastolic BP, pulse pressure, and mean arterial pressure. They examined almost 145,000 longitudinal BP measures collected over a 43-year period from 1971 to 2014 from four different community cohort studies in the United States. The study confirmed that for women, an increase in BP begins as early the third decade of life, and that this trajectory persisted, even after adjustment for cardiovascular-disease risk factors (P for all <.001).
The team emphasized, “Our research not only confirms that women have different biology and physiology than their male counterparts, but also illustrates why it is that women may be more susceptible to developing certain types of cardiovascular disease and at different points in life.”
“If we assume that women and men exhibit variations of the same fundamental vascular physiology, then conventional analyses of subclinical measures would suggest that women catch up to men by midlife in the extent of potentially important vascular disease. Alternatively, under the assumption that vascular physiology may fundamentally differ between women and men, a sex-specific analysis of existing data could offer new insights and augment our understanding of sex differences in cardiovascular diseases,” they concluded.
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