Abstract
Pulmonary hypertension (PH) includes multiple diseases that share as common characteristic an elevated pulmonary artery pressure and right ventricular involvement. Sex differences are observed in practically all causes of PH. The most studied type is pulmonary arterial hypertension (PAH) which presents a gender bias regarding its prevalence, prognosis, and response to treatment. Although this disease is more frequent in women, once affected they present a better prognosis compared to men. Even if estrogens seem to be the key to understand these differences, animal models have shown contradictory results leading to the birth of the estrogen paradox. In this review we will summarize the evidence regarding sex differences in experimental animal models and, very specially, in patients suffering from PAH or PH from other etiologies.
Highlights
Sex constitutes a non-modifiable risk marker for several diseases (Khamis et al, 2016; Mattiuzzi and Lippi, 2019) but in few of them its consequences represent such a challenge as in pulmonary hypertension (PH)
Complex mechanisms involving a dysregulation of nitric oxide, endothelin-1 production and the intervention of multiple cell types like pulmonary artery smooth muscle cells (PASMCs), pulmonary artery endothelial cells (PAEs) and fibroblasts constitute the hallmarks of pulmonary arterial hypertension (PAH), they are involved to a lesser or greater degree in all cases of PH (Humbert et al, 2019)
Sex differences are observed in practically all groups of PH
Summary
Reviewed by: Stevan Tofovic, University of Pittsburgh, United States Sharath C. Sex differences are observed in practically all causes of PH. The most studied type is pulmonary arterial hypertension (PAH) which presents a gender bias regarding its prevalence, prognosis, and response to treatment. This disease is more frequent in women, once affected they present a better prognosis compared to men. Even if estrogens seem to be the key to understand these differences, animal models have shown contradictory results leading to the birth of the estrogen paradox. In this review we will summarize the evidence regarding sex differences in experimental animal models and, very specially, in patients suffering from PAH or PH from other etiologies
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