Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
Can J Cardiol. 2021 Jul;37(7):980-991. doi: 10.1016/j.cjca.2021.02.003. Epub 2021 Feb 11.
Valvular heart diseases have long been considered to be similar in men and women and across races/ethnicities. Recently, studies have demonstrated major differences between sexes. Unfortunately, studies on valvular heart diseases, as on other cardiovascular diseases, are mostly performed in Caucasian men or in cohorts with a vast majority of Caucasian men. Therefore, our knowledge on valvular diseases in women and non-Caucasians remains limited. Nevertheless, aortic stenosis has been shown to be almost as prevalent in women as in men, and less prevalent in African Americans. Men appear to have a more calcified aortic valve lesion, and women tend to have a more fibrosed one. Primary mitral regurgitation is more frequent in women who have more rheumatic and Barlow etiologies, whereas men have more fibroelastic deficiency and posterior leaflet prolapse/flail. Left ventricular remodelling due to valvular heart diseases is sex related in terms of geometry and probably also in composition of the tissue. Outcomes seem to be worse in women after surgical interventions and better than or equivalent to men after transcatheter ones. Regarding other valvular heart diseases, very few studies are available: Aortic regurgitation is more frequent in men, isolated tricuspid regurgitation more frequent in women. Rheumatic valve diseases are more frequent in women and are mostly represented by mitral and aortic stenoses. Many other sex/gender- and race/ethnic-specific studies are still needed in epidemiology, pathophysiology, presentation, management, and outcomes. This review aims to report the available data on sex differences and race specificities in valvular heart diseases, with a primary focus on aortic stenosis and mitral regurgitation.
瓣膜性心脏病长期以来被认为在男性和女性以及不同种族/民族之间相似。最近的研究表明，男女之间存在重大差异。不幸的是，瓣膜性心脏病的研究，就像其他心血管疾病一样，主要在白种男性或绝大多数白种男性的队列中进行。因此，我们对女性和非白种人瓣膜疾病的了解仍然有限。然而，研究表明，女性主动脉瓣狭窄的患病率几乎与男性相同，而在非裔美国人中则较低。男性似乎具有更钙化的主动脉瓣病变，而女性则倾向于具有更纤维化的病变。原发性二尖瓣反流在具有更多风湿和巴洛病因的女性中更为常见，而男性则具有更多的纤维弹性缺乏和后瓣叶脱垂/游离。由于瓣膜性心脏病，左心室重构在几何形状上与性别有关，组织的组成也可能有关。女性在接受手术干预后的结果似乎比男性差，而在接受经导管治疗后的结果比男性好或与男性相当。关于其他瓣膜性心脏病，很少有研究：主动脉瓣反流在男性中更为常见，单纯三尖瓣反流在女性中更为常见。风湿性瓣膜病在女性中更为常见，主要表现为二尖瓣和主动脉狭窄。在流行病学、病理生理学、表现、管理和结果方面，仍需要进行许多其他基于性别的和种族/民族特异性的研究。这篇综述旨在报告瓣膜性心脏病中性别差异和种族特异性的现有数据，主要关注主动脉瓣狭窄和二尖瓣反流。
