Gender-Related Divergences in Cardiac and Vascular Function with Age

Heart failure with preserved ejection fraction (HFpEF) is a highly morbid clinical syndrome of increasing prevalence. The syndrome is defined by the presence of signs and symptoms of heart failure, diastolic dysfunction, and an ejection fraction ≥ 50%. Advanced age and female sex are two important risk factors for developing HFpEF, with women twice as likely as men to develop the condition for reasons that are incompletely understood. Diastolic function also changes with age; thus, distinguishing senescent changes from pathological changes is important. Understanding the ages at which parameters of cardiac and vascular function change may provide insight about the pathophysiology of HFpEF and its disproportionate burden in women.

At #AHA22, we presented data from 179 healthy, sedentary, non-obese participants ages 20-90 who underwent assessments of vascular and cardiac function, including right heart catheterization and Doppler echocardiography. Starting at age 55, women experienced higher systolic blood pressure, slower diastolic recoil, and slower peak mitral annular systolic velocity than men. These findings suggest a greater decline in diastolic function that may be due to intrinsic changes to the myocardium, including collagen deposition, increased wall thickness, and decreased cavity size, as well as sustained exposure to increased afterload. Women demonstrated higher arterial elastance, largely driven by smaller stroke volumes relative to their male counterparts. There were no significant differences in left ventricular filling pressures between genders across the age spectrum.

Given that many of the changes in diastolic and vascular function occurred after menopause, hormonal and lifestyle factors may be important contributors to the increased risk of HFpEF in women. In future studies, we will explore potential causes for these observed age-related changes in vascular and cardiac function, including myocardial stiffness, end-systolic and end-diastolic left ventricular volumes, and serum hormone levels.