Abstract
Calcific aortic valve disease (CAVD) is the most common valvular heart disease in developed countries predominantly affecting the elderly population therefore posing a large economic burden. It is a gradually progressive condition ranging from mild valve calcification and thickening, without the hemodynamic obstruction, to severe calcification impairing leaflet motion, known as aortic stenosis (AS). The progression of CAVD occurs over many years, and it is extremely variable among individuals. It is also associated with an increased risk of coronary events and mortality. The recent insights into the CAVD pathophysiology included an important role of sex. Accumulating evidence suggests that, in patients with CAVD, sex can determine important differences in the relationship between valvular calcification process, fibrosis, and aortic stenosis hemodynamic severity between men and women. Consequently, it has implications on the development of different valvular phenotypes, left ventricular hypertrophy, and cardiovascular outcomes in men and women. Along these lines, taking into account the sex-related differences in diagnosis, prognosis, and treatment outcomes is of profound importance. In this review, the sex-related differences in patients with CAVD, in terms of pathobiology, clinical phenotypes, and outcomes were discussed.
Highlights
Calcific aortic valve disease (CAVD) is the most frequent valvular heart disease in the Western world that, in the USA alone, affects 2.5% of the senior population accounting for 17,000 deaths annually [1]
The prevalence of CAVD increases with age and the male sex recognized as risk factor for aortic stenosis (AS), the end-stage of the disease [2]
The Multi-Ethnic Study of Atherosclerosis showed that the aortic valve calcification (AVC) incidence rate increased significantly with age and its risk of progression was associated with male sex and Agatston score at baseline [3]
Summary
Calcific aortic valve disease (CAVD) is the most frequent valvular heart disease in the Western world that, in the USA alone, affects 2.5% of the senior population (older than 65 years of age) accounting for 17,000 deaths annually [1]. The Multi-Ethnic Study of Atherosclerosis showed that the aortic valve calcification (AVC) incidence rate increased significantly with age and its risk of progression was associated with male sex and Agatston score at baseline [3]. It was estimated that 12.4% (Europe) and 3.4% (North America) of the general elderly population (75 years and older) have symptomatic severe aortic stenosis (AS), the end stage of CAVD [5]. These figures are set to rise with current trends in the population demographics (i.e., ageing of the population) and the deficiency in effective prevention strategies [5]. Sex-related differences in patients with CAVD in terms of pathobiology, clinical phenotypes, and outcomes were discussed
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