Sex Differences In Prevalence Research Articles

Association Between Risk Factors in Childhood and Sex Differences in Prevalence of Carotid Artery Plaques and Intima-Media Thickness in Mid-Adulthood in the Childhood Determinants of Adult Health Study.

Background The origins of sex differences in cardiovascular diseases are not well understood. We examined the contribution of childhood risk factors to sex differences in adult carotid artery plaques and intima-media thickness (carotid IMT). Methods and Results Children in the 1985 Australian Schools Health and Fitness Survey were followed up whentheywereaged 36 to 49 years (2014-19, n=1085-1281). Log binomial and linear regression examined sex differences in adult carotid plaques (n=1089) or carotid IMT (n=1283). Childhood sociodemographic, psychosocial, and biomedical risk factors that might contribute to sex differences in carotid IMT/plaques were examined using purposeful model building with additional adjustment for equivalent adult risk factors in sensitivity analyses. Women less often had carotid plaques (10%) than men (17%). The sex difference in the prevalence of plaques (relativerisk[RR] unadjusted 0.59 [95% CI, 0.43 to 0.80]) was reduced by adjustment for childhood school achievement and systolic blood pressure (RRadjusted 0.65 [95% CI, 0.47 to 0.90]). Additional adjustment for adult education and systolic blood pressure further reduced sex difference (RR adjusted 0.72 [95% CI, 0.49 to 1.06]). Women (mean±SD 0.61±0.07) had thinner carotid IMT than men (mean±SD 0.66±0.09). The sex difference in carotid IMT (β unadjusted -0.051 [95% CI, -0.061 to -0.042]) reduced with adjustment for childhood waist circumference and systolic blood pressure (β adjusted -0.047 [95% CI, -0.057 to -0.037]) and further reduced with adjustment for adult waist circumference and systolic blood pressure (β adjusted -0.034 [95% CI, -0.048 to -0.019]). Conclusions Some childhood factors contributed to adult sex differences in plaques and carotid IMT. Prevention strategies across the life course are important to reduce adult sex differences in cardiovascular diseases.

Could Country-Level Factors Explain Sex Differences in Dementia Incidence and Prevalence? A Systematic Review and Meta-Analysis.

Despite rising interest in sex differences in dementia, it is unclear whether sex differences in dementia incidence and prevalence are apparent globally. We examine sex differences in incidence and prevalence of Any dementia, Alzheimer's disease (AD), and vascular dementia (VaD), and evaluate whether country-level indicators of gender inequality account for differences. Systematic review with meta-analysis was used to obtain estimates of incidence and prevalence of Any dementia, AD, and VaD using random effects meta-analysis, and population-based studies with clinical or validated dementia measures. Meta-regression was used to evaluate how country-specific factors of life expectancy, education, and gender differences in development, unemployment, and inequality indices influenced estimates. We identified 205 eligible studies from 8,731 articles, representing 998,187 participants across 43 countries. There were no sex differences in the incidence of Any dementia, AD, or VaD, except in the 90+ age group (women higher). When examined by 5-year age bands, the only sex difference in prevalence of Any dementia was in the 85+ group and there was no sex difference in VaD. AD was more prevalent in women at most ages. Globally, the overall prevalence of dementia in adults 65 + was higher for women (80.22/1000, 95% CI 62.83-97.61) than men (54.86/1000, 95% CI 43.55-66.17). Meta-regression revealed that sex differences in Any dementia prevalence were associated with gender differences in life expectancy and in education. Globally, there are no sex differences in age-specific dementia incidence, but prevalence of AD is higher in women. Country-level factors like life expectancy and gender differences in education may explain variability in sex differences.

Analysis of transcriptional changes in the immune system associated with pubertal development in a longitudinal cohort of children with asthma

Puberty is an important developmental period marked by hormonal, metabolic and immune changes. Puberty also marks a shift in sex differences in susceptibility to asthma. Yet, little is known about the gene expression changes in immune cells that occur during pubertal development. Here we assess pubertal development and leukocyte gene expression in a longitudinal cohort of 251 children with asthma. We identify substantial gene expression changes associated with age and pubertal development. Gene expression changes between pre- and post-menarcheal females suggest a shift from predominantly innate to adaptive immunity. We show that genetic effects on gene expression change dynamically during pubertal development. Gene expression changes during puberty are correlated with gene expression changes associated with asthma and may explain sex differences in prevalence. Our results show that molecular data used to study the genetics of early onset diseases should consider pubertal development as an important factor that modifies the transcriptome.

Sex differences in the medial prefrontal cortical glutamate system

BackgroundDysregulation in the prefrontal cortex underlies a variety of psychiatric illnesses, including substance use disorder, depression, and anxiety. Despite the established sex differences in prevalence and presentation of these illnesses, the neural mechanisms driving these differences are largely unexplored. Here, we investigate potential sex differences in glutamatergic transmission within the medial prefrontal cortex (mPFC). The goal of these experiments was to determine if there are baseline sex differences in transmission within this region that may underlie sex differences in diseases that involve dysregulation in the prefrontal cortex.MethodsAdult male and female C57Bl/6J mice were used for all experiments. Mice were killed and bilateral tissue samples were taken from the medial prefrontal cortex for western blotting. Both synaptosomal and total GluA1 and GluA2 levels were measured. In a second set of experiments, mice were killed and ex vivo slice electrophysiology was performed on prepared tissue from the medial prefrontal cortex. Spontaneous excitatory postsynaptic currents and rectification indices were measured.ResultsFemales exhibit higher levels of synaptosomal GluA1 and GluA2 in the mPFC compared to males. Despite similar trends, no statistically significant differences are seen in total levels of GluA1 and GluA2. Females also exhibit both a higher amplitude and higher frequency of spontaneous excitatory postsynaptic currents and greater inward rectification in the mPFC compared to males.ConclusionsOverall, we conclude that there are sex differences in glutamatergic transmission in the mPFC. Our data suggest that females have higher levels of glutamatergic transmission in this region. This provides evidence that the development of sex-specific pharmacotherapies for various psychiatric diseases is important to create more effective treatments.

Sex differences in prevalence of electrocardiographic and echocardiographic left ventricular hypertrophy among patients with coronary artery disease

Abstract Background Both electrocardiographic left ventricular hypertrophy (ECG-LVH) and echocardiographic LVH (echo-LVH) are associated with higher risk of cardiovascular and sudden cardiac death. ECG-LVH seems to be partly distinct from echo-LVH as many subjects with echo-LVH do not have ECG-LVH and vice versa. The difference between sexes have not been studied earlier. Purpose The aim of this study was to determine sex differences in prevalence of ECG-LVH and echo-LVH among patients with coronary artery disease (CAD) and to study if ECG-LVH would have higher accuracy for echo-LVH in either of sexes. Methods Standard 12-lead electrocardiograms and echocardiographic measurements were studied from 1,894 subjects of ARTEMIS Study (31.8% women). Echo-LVH was determined as estimated left ventricular (LV) mass ≥201 g in men and ≥151 g in women and was categorized as mildly, moderately and severely abnormal. ECG-LVH was determined if either criteria of Sokolow-Lyon or Cornell were met. Results Echo-LVH was found from 1,162 of the study subjects (women 34.3%, p=0.004) and ECG-LVH only from 222 of the subjects (women 55.9%, p<0.001). Of those with ECG-LVH, 82.0% had increased LV mass (p<0.001), and ECG-LVH seemed to correlate slightly better to echo-LVH in women than in men (82.3% vs. 81.6%, p<0.001). Of those with ECG-LVH, 47.7% had severe echo-LVH (p<0.001). The prevalence of ECG-LVH was the higher the greater the LV mass was. Among men with ECG-LVH, 46.9% had severe echo-LVH (p<0.001). Among women with ECG-LVH, 16.1% had mild echo-LVH (p=0.029) and 48.4% severe echo-LVH (p<0.001). In addition, 18% of those with ECG-LVH did not have echo-LVH (p<0.001). This proportion was slightly smaller in women than in men (17.7% vs. 18.4%, p<0.001). Only 15.7% of the subjects with echo-LVH had ECG-LVH (p<0.001). This proportion was significantly higher in women than in men (25.6% vs. 10.5%, p<0.001). ECG-LVH was more common finding in subjects with severe echo-LVH as 20.9% of those CAD patients had ECG-LVH (p<0.001). Among women with severe echo-LVH, ECG-LVH was found in 35.3% (p<0.001) whereas only in 13.7% of men with severe echo-LVH (p<0.001). The prevalence of ECG-LVH seemed to be considerably higher among female CAD patients with T2DM and without prior MI as ECG-LVH was seen in 33.0% of those subjects with at least midl echo-LVH (p<0.001) and 43.8% of those subjects with severe echo-LVH (p<0.001). In male patients from similar subgroup and some degree of echo-LVH, ECG-LVH was seen in 6.7% (p=0.042) and with severe echo-LVH in 12.2% (p<0.001) of the subjects. Conclusions In patients with CAD echo-LVH was often seen without signs of ECG-LVH, especially in men. Majority of the CAD patients with ECG-LVH had also echo-LVH and the prevalence on ECG-LVH was the higher the greater the LV mass was. ECG-LVH seemed to correlate better to anatomic LVH in women with CAD than in men, and the sex difference was highlighted in CAD patients with T2DM and no prior MI. Funding Acknowledgement Type of funding sources: None.

Stress during puberty exerts sex-specific effects on depressive-like behavior and monoamine neurotransmitters in adolescence and adulthood

Psychiatric disorders including major depression are twice as prevalent in women compared to men. This sex difference in prevalence only emerges after the onset of puberty, suggesting that puberty may be a sensitive period during which sex-associated vulnerability to stress-related depression might become established. Thus, this study investigated whether stress occurring specifically during the pubertal window of adolescence may be responsible for this sex difference in depression vulnerability. Male and female rats were exposed to a three-day stress protocol during puberty (postnatal days 35–37 in females, 45–47 in males) and underwent behavioral tests in adolescence or adulthood measuring anhedonia, anxiety-like behavior, locomotor activity and antidepressant-like behavior. Brainstem and striatum tissue were collected from a separate cohort of behavioral test-naïve rats in adolescence or adulthood to quantify the effect of pubertal stress on monoamine neurotransmitters. Pubertal stress increased immobility behavior in the forced swim test in both sexes in adolescence and adulthood. In adolescence, pubertal stress altered escape-oriented behaviors in a sex-specific manner: decreasing climbing in males but not females and decreasing swimming in females but not males. Pubertal stress decreased adolescent brainstem noradrenaline specifically in females and had opposing effects in adolescent males and females on brainstem serotonin turnover. Pubertal stress induced anhedonia in the saccharin preference test in adult males but not females, an effect paralleled by a male-specific decrease in striatal dopamine turnover. Pubertal stress did not significantly impact anxiety-like behavior or locomotor activity in any sex at either age. Taken together, these data suggest that although pubertal stress did not preferentially increase female vulnerability to depressive-like behaviors compared to males, stress during puberty exerts sex-specific effects on depressive-like behavior and anhedonia, possibly through discrete neurotransmitter systems.

Sex-differences in prevalence and outcomes of the different endotypes of chronic coronary syndrome – analysis from the multi-center international ILIAS Registry

Abstract Introduction Guideline-directed management of chronic coronary syndrome (CCS) remains focused on obstructive causes of angina, and is based on established therapies derived from studies predominantly including men. This occurs despite documented higher mortality from cardiovascular causes in women compared to men, which is hypothesized to be related to a higher prevalence of coronary microvascular dysfunction (CMD) in women. However, data on the relationship between sex, the different endotypes of CCS, and related sex-specific clinical outcomes are limited. Purpose This study aimed to investigate the relationship between sex and the different endotypes of CCS, as well as sex-specific clinical outcomes of CCS endotypes. Method In patients with stable angina undergoing coronary angiography, the following invasive coronary hemodynamics were characterized: fractional flow reserve (FFR; <0.80 considered abnormal), coronary flow reserve (CFR; <2.0 considered abnormal) and microcirculatory resistance (MR) (hyperemic microvascular resistance; >2.5mmHg/cm/sec or index of microvascular resistance >25 considered abnormal). Patients were stratified into three groups: 1) hemodynamically significant obstructive coronary artery disease (oCAD) (FFR abnormal or a severe coronary stenosis requiring revascularization), 2) no-obstructive coronary artery disease but with CMD (FFR normal, but abnormal CFR and/or MR), or 3) no-obstructive coronary artery disease and no CMD (FFR normal, and normal CFR and MR). We assessed the prevalence of the CCS endotypes across sex, and sex-specific cardiovascular outcomes over a follow-up of 7 years defined as the composite endpoint of death or acute myocardial infarction. Results Amongst a total of 1987 included patients, 1435 (72.2%) were men and 552 (27.8%) were women. oCAD occurred in 904 (45.5%) patients, which was significantly more prevalent in men (48.9% (701/1435) of men vs. 36.8% (203/552) of women, p<0.001). In contrast, CMD was significantly more prevalent in women (19.6% (281/1435) of men vs. 24.1% (133/552) of women, p=0.031). Across the population, either oCAD or CMD occurred in 68.4% of men versus 60.9% of women (p=0.002). There were no sex-specific differences in cardiovascular outcomes across CCS entities (Figure 1). Conclusion In patients evaluated for CCS who underwent clinically indicated coronary angiography and physiological assessment, men were more likely to have oCAD and women were more likely to be classified as CMD. There were no sex-related differences in the prognosis associated with the individual CCS endotypes. Therefore, pathophysiological changes in the coronary circulation potentially underlying angina pectoris are similarly prevalent in men and women, but the high incidence of CMD in women makes women prone to underdiagnosis if no additional physiological measurements are assessed. Funding Acknowledgement Type of funding sources: None.

3.40 Eye-Tracking Biomarkers of Social Attention Are Related to Naturalistic Social Interactions in Children With ASD

Eye-tracking (ET) measures indexing social attention have been proposed as sensitive biomarkers of ASD. However, less is known about the relationship between social attention biomarkers and naturalistic measures of social engagement. This study investigated ET biomarkers of social attention as predictors of social engagement during a naturalistic parent-child interaction. Sex was included as a moderator due to known sex differences in prevalence and behavioral features of ASD.

Behaviorally penetrant, anomalous dopamine efflux exposes sex and circuit dependent regulation of dopamine transporters.

Virtually all neuropsychiatric disorders display sex differences in prevalence, age of onset, and/or clinical symptomology. Although altered dopamine (DA) signaling is a feature of many of these disorders, sex-dependent mechanisms uniquely responsive to DA that drive sex-dependent behaviors remain unelucidated. Previously, we established that anomalous DA efflux (ADE) is a prominent feature of the DA transporter (DAT) variant Val559, a coding substitution identified in two male-biased disorders: attention-deficit/hyperactivity disorder and autism spectrum disorder. In vivo, Val559 ADE induces activation of nigrostriatal D2-type DA autoreceptors (D2ARs) that magnifies inappropriate, nonvesicular DA release by elevating phosphorylation and surface trafficking of ADE-prone DAT proteins. Here we demonstrate that DAT Val559 mice exhibit sex-dependent alterations in psychostimulant responses, social behavior, and cognitive performance. In a search for underlying mechanisms, we discovered that the ability of ADE to elicit D2AR regulation of DAT is both sex and circuit-dependent, with dorsal striatum D2AR/DAT coupling evident only in males, whereas D2AR/DAT coupling in the ventral striatum is exclusive to females. Moreover, systemic administration of the D2R antagonist sulpiride, which precludes ADE-driven DAT trafficking, can normalize DAT Val559 behavioral changes unique to each sex and without effects on the opposite sex or wildtype mice. Our studies support the sex- and circuit dependent capacity of D2ARs to regulate DAT as a critical determinant of the sex-biased effects of perturbed DA signaling in neurobehavioral disorders. Moreover, our work provides a cogent example of how a shared biological insult drives alternative physiological and behavioral trajectories as opposed to resilience.

Sex differences of vascular brain lesions in patients with atrial fibrillation

ObjectiveTo examine sex differences in prevalence, volume and distribution of vascular brain lesions on MRI among patients with atrial fibrillation (AF).MethodsIn this cross-sectional analysis, we included 1743 patients with AF...

TCT-563 Sex Differences in Prevalence and Outcomes of the Different Endotypes of Chronic Coronary Syndrome in Patients With Angina Referred to the Cathlab

TCT-563 Sex Differences in Prevalence and Outcomes of the Different Endotypes of Chronic Coronary Syndrome in Patients With Angina Referred to the Cathlab

Sex differences in prevalence and clinical correlates of insomnia in Chinese patients with chronic schizophrenia.

It is generally recognized that there are sex differences in many aspects of schizophrenia. The main purpose of this study was to investigate the sex differences in the prevalence and clinical correlates of insomnia in patients with chronic schizophrenia. A total of 957 patients who met the DSM-IV diagnostic criteria for schizophrenia were recruited in this cross-sectional study (male/female = 630/327). Demographic, clinical, and insomnia data were collected using self-reported questionnaires. Fasting blood samples were collected to evaluate the status of blood lipids. Psychopathological symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS). The prevalence rate of insomnia in female patients with schizophrenia was significantly higher than that in male patients (17.3% for males and 26.3% for females; χ2 = 10.74, p = 0.001). Regression analysis showed that in male patients, insomnia was independently associated with severe PANSS positive symptoms, severe PANSS depressive factor, and high levels of low-density lipoprotein levels, while in female patients, insomnia was associated with low education level, high PANSS depressive factor, and high levels of apolipoprotein B levels. This study illustrates that insomnia is more frequent in female than male schizophrenia patients, and that there are differences in the clinical correlates of insomnia by sex, suggesting that sex differences should be considered in prevention and treatment strategies for coexisting insomnia in schizophrenia patients.

Differential Regulation of Mouse Hippocampal Gene Expression Sex Differences by Chromosomal Content and Gonadal Sex.

Common neurological disorders, like Alzheimer’s disease (AD), multiple sclerosis (MS), and autism, display profound sex differences in prevalence and clinical presentation. However, sex differences in the brain with health and disease are often overlooked in experimental models. Sex effects originate, directly or indirectly, from hormonal or sex chromosomal mechanisms. To delineate the contributions of genetic sex (XX v. XY) versus gonadal sex (ovaries v. testes) to the epigenomic regulation of hippocampal sex differences, we used the Four Core Genotypes (FCG) mouse model which uncouples chromosomal and gonadal sex. Transcriptomic and epigenomic analyses of ~ 12-month-old FCG mouse hippocampus, revealed genomic context-specific regulatory effects of genotypic and gonadal sex on X- and autosome-encoded gene expression and DNA modification patterns. X-chromosomal epigenomic patterns, classically associated with X-inactivation, were established almost entirely by genotypic sex, independent of gonadal sex. Differences in X-chromosome methylation were primarily localized to gene regulatory regions including promoters, CpG islands, CTCF binding sites, and active/poised chromatin, with an inverse relationship between methylation and gene expression. Autosomal gene expression demonstrated regulation by both genotypic and gonadal sex, particularly in immune processes. These data demonstrate an important regulatory role of sex chromosomes, independent of gonadal sex, on sex-biased hippocampal transcriptomic and epigenomic profiles. Future studies will need to further interrogate specific CNS cell types, identify the mechanisms by which sex chromosomes regulate autosomes, and differentiate organizational from activational hormonal effects.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12035-022-02860-0.

SEX DIFFERENCES IN PRE-EXISTING CLINICAL COMORBIDITIES AND PRESCRIBED TREATMENTS IN PATIENTS WITH POST-TRAUMATIC KNEE OSTEOARTHRITIS

Purpose: It is widely accepted that sex differences in prevalence, severity, pain, and mental health are present in patients with idiopathic knee OA. However, it is unknown if sex differences are also present in patients with PTOA or if treatment utilization changes between sexes. Given these distinct differences between PTOA and OA patients it is important to identify if there are sex differences in clinical comorbidities and treatment utilization for patients with PTOA. The purpose of this study was to describe the differences in medical comorbidity prevalence and treatment utilization between sexes in patients with post-traumatic knee osteoarthritis.

Race, Ethnic, and Sex Differences in Prevalence of and Trends in Hallucinogen Consumption Among Lifetime Users in the United States Between 2015 and 2019.

The current study is one of the first to examine race, ethnic, and sex differences in the prevalence of and trends in hallucinogen use among lifetime users in the United States. Data came from the 2015-2019 National Survey on Drug Use and Health and included respondent's reporting ever-using hallucinogens (n = 41,060; female = 40.4%). Descriptive and multinomial logistic regression analyses were conducted in Stata. Highest prevalence of past year hallucinogen use was among Asian females (35.06%), which was two-or-more times larger than prevalence of past year use among White males/females and Native American males. More than half of White males/females, Multiracial males, and Hispanic males reported had ever-used psilocybin or LSD, whereas less than one-quarter of Black males/females reported lifetime psilocybin use, and less than a third of Black females reported lifetime LSD use. Native American males had the lowest prevalence of lifetime MDMA use (17.62-33.30%) but had the highest lifetime prevalence of peyote use (40.37-53.24%). Pacific Islander males had the highest prevalence of lifetime mescaline use (28.27%), and lifetime DMT use was highest among Pacific Islander males/females (15.68-38.58%). Black, Asian, and Multiracial people had greater odds of past-year (ORs = 1.20-2.02; ps < 0.05) and past-month (ORs = 1.39-2.06; ps < 0.05) hallucinogen use compared to White people. Females had lower odds of past-year (OR = 0.79; ps < 0.05), past-month (OR = 0.78; ps < 0.05) hallucinogen use compared to males, except for lifetime use of MDMA (OR = 1.29; ps < 0.05). These findings should inform public health initiatives regarding potential benefits and risks of hallucinogen use among racial/ethnic groups and women.

Sex Differences in Aortopathy and Valve Diseases Among Patients Undergoing Cardiac Surgical Procedure

BackgroundWe aimed to study sex differences in aortopathy and valve disease among patients undergoing aortic valve replacement and/or surgical procedure for ascending aortic aneurysm and assess whether differences are specific for patients with bicuspid aortic valve (BAV) compared with patients with tricuspid aortic valve. MethodsWe used a single-center and observational cohort including 1045 patients undergoing elective open heart surgical procedure for aortic valve disease and/or ascending aortic aneurysm at the Karolinska Hospital (Stockholm, Sweden). ResultsWomen (33.0%) were older than men (mean [SD]; 67.9 [11] years vs 62.5 [13] years for men; P < .001). No significant sex difference in prevalence of ascending aortic aneurysm was found according to absolute measures (P = .19); however, women had a greater dilation of the ascending aorta when normalized for body surface area (mean, 21.8 [SD, 6.3] mm/m2 vs 19.3 [SD, 4.4] mm/m2 for men; P < .001). Among the 560 patients with BAV, women had significantly more aortic stenosis (adjusted odds ratio, 2.23; 95% CI, 1.19-4.20; P = .013) and less aortic insufficiency (adjusted odds ratio, 0.42; 95% CI, 0.23-0.78; P < .01); whereas no sex difference was found among patients with tricuspid aortic valve. ConclusionsIn this large study of patients undergoing cardiac surgical procedure, we found a greater degree of aortic dilation in women compared with men, suggesting a need for earlier monitoring of women. Moreover, women with BAV had a significantly higher prevalence of aortic stenosis compared with men. These results describe the aorta and valvular characteristics of patients by sex and provide guidance regarding which patients might benefit from closer surveillance.

Epidemiological differences between sexes affect management efficacy in simulated chronic wasting disease systems

Abstract Sex‐based differences in physiology, behaviour and demography commonly result in differences in disease prevalence. However, sex differences in prevalence may reflect exposure rather than transmission, which could affect disease control programmes. One potential example is chronic wasting disease (CWD), which has been observed at greater prevalence among male than female deer. We used an age‐ and sex‐structured simulation model to explore harvest‐based management of CWD under three different transmission scenarios that all generate higher male prevalence: (1) increased male susceptibility, (2) high male‐to‐male transmission or (3) high female‐to‐male transmission. Both female and male harvests were required to limit CWD epidemics across all transmission scenarios (approximated by R0), though invasion was more likely under high female‐to‐male transmission. In simulations, heavily male‐biased harvests controlled CWD epidemics and maintained large host populations under high male‐to‐male transmission and increased male susceptibility scenarios. However, male‐biased harvests were ineffective under high female‐to‐male transmission. Instead, female‐biased harvests were able to limit disease transmission under high female‐to‐male transmission but incurred a trade‐off with smaller population sizes. Synthesis and applications. Higher disease prevalence in a sex or age group may be due to higher exposure or susceptibility but does not necessarily indicate if that group is responsible for more disease transmission. We showed that multiple processes can result in the pattern of higher male prevalence, but that population‐level management interventions must focus on the sex responsible for disease transmission, not just those that are most exposed.

Sex-specific echocardiographic phenotypes in left ventricular outflow tract obstruction

Abstract Funding Acknowledgements Type of funding sources: None. Background Previous studies have reported major sex differences in prevalence, demographics, and timing of intervention in left ventricular outflow tract (LVOT) obstruction. Whether the observed differences are related to LVOT anatomy is less explored. Purpose The aim of this study was to assess the anatomic substrate for LVOT obstruction by echocardiography to identify sex-specific phenotypes. Methods We included 76 patients (37% women) with symptomatic LVOT obstruction referred to a tertiary care centre between 2005-2020 to be considered for septal ablation or myectomy. A standardized echocardiography was extended with systematic measurements of parasternal LVOT dimensions at 5, 10 and 15 mm below the aortic valve, proximal septal thickness at 10, 20 and 30 mm, subaortic septal bulge radius and aortoseptal angle in all patients prior to intervention (Image). Measurements were also adjusted for body surface area (BSA). A total of 3 patients had to be excluded from analysis due to poor image quality. Results Women were older (p &amp;lt; 0.001, Table), while there were no differences in body mass index (27.6 v.s. 27.5, p = ns), systolic and diastolic blood pressure (133 v.s 133 mmHg, p = ns and 75 v.s 80 mmHg, p = ns, respectively), or prevalence of hypertension (24% v.s. 29%, p = n.s). Left ventricular end-diastolic diameter, LVOT diameters and septum thickness measured 30 mm from the aortic valve were lower in women (Table). However, in all these measurements the differences disappeared after adjusting for BSA. There were no sex differences in posterior wall thickness. Furthermore, the aortoseptal angle was steeper among women, and the septum bulge radius smaller, remaining so even after adjustment for BSA(Table). Conclusion In women with LVOT obstruction, the septum bulge radius adjusted for BSA was smaller, and the aortoseptal angle steeper. Our findings suggest that there may be important sex differences in the echocardiographic phenotype in LVOT obstruction. Abstract Table Abstract Figure. Image

Comparing the Risk of M. Tuberculosis Infection among Men and Women in an African City

Background: Despite the well-known male bias in tuberculosis disease, the underlying reasons remained elusive. We examined whether male predominance in tuberculosis disease is result of higher risk of tuberculosis infection or not. If so, whether it is due to higher likelihood of exposure or higher susceptibility to infection among men. Methods: A household contact study and a prospective cohort study conducted in Kampala, Uganda, from 2013 to 2017 were used to estimate and compare prevalence and annual risk of tuberculosis infection among men and women. In household contact study, index tuberculosis cases and healthy index controls were asked to list their household contacts and extra-household contacts. All contacts were tested with tuberculin skin test to detect tuberculosis infection. In prospective cohort study, individuals with tuberculin skin test (TST) &lt; 5 mm were enrolled and retested with the skin test at one year to detect new infection. Poisson regression with robust standard errors was used to estimate prevalence ratio and relative risk of tuberculous infection between men and women. Results: In household contact study, 123 index tuberculosis cases and 124 index controls listed 382 household contacts of tuberculosis cases, 624 extra-household contacts of tuberculosis cases, and 1044 contacts of controls. Of 1681 enrolled participants in cohort study, 1213 (72%) were retested with TST at one year. There was no sex difference in prevalence of tuberculosis infection among household contacts of tuberculosis cases, but men had a higher prevalence of tuberculosis infection among extra-household contacts of tuberculosis cases (prevalence ratio 1.25, 95% CI 1.06 – 1.48) and contacts of controls (prevalence ratio 1.53, 95% CI 1.30 – 1.81). Similarly, in cohort study, there was no sex difference in annual risk of tuberculosis infection when participant reported knowing tuberculosis cases, but men had a higher annual risk of tuberculosis infection when participants no known contact with tuberculosis (relative risk 1.94, 95% CI: 1.34, 2.80). Conclusion: Men have higher risk of acquiring tuberculous infection than women. Men and women may have the same susceptibility to tuberculosis infection given known exposure to tuberculosis cases. The observed difference in rate of infection may be partially explained by higher rates of exposure to undetected, infectious tuberculosis cases among men.

Sex Differences in Neurodevelopmental Disorders: A Key Role for the Immune System.

Sex differences are prominent defining features of neurodevelopmental disorders. Understanding the sex biases in these disorders can shed light on mechanisms leading to relative risk and resilience for the disorders, as well as more broadly advance our understanding of how sex differences may relate to brain development. The prevalence of neurodevelopmental disorders is increasing, and the two most common neurodevelopmental disorders, Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) exhibit male-biases in prevalence rates and sex differences in symptomology. While the causes of neurodevelopmental disorders and their sex differences remain to be fullyunderstood, increasing evidence suggests that the immune system plays a critical role in shaping development. In this chapter we discuss sex differences in prevalence and symptomology of ASD and ADHD, review sexual differentiation and immune regulation of neurodevelopment, and discuss findings from human and rodent studies of immune dysregulation and perinatal immune perturbation as they relate to potential mechanisms underlying neurodevelopmental disorders. This chapter will give an overview of how understanding sex differences in neuroimmune function in the context of neurodevelopmental disorders could lend insight into their etiologies and better treatment strategies.