Bhatt Nitish, Chung Jennifer Chia-Ying
Faculty of Medicine, University of Toronto.
Division of Cardiovascular Surgery, University Health Network, Toronto, Ontario, Canada.
Curr Opin Cardiol. 2023 Mar 1;38(2):75-81. doi: 10.1097/HCO.0000000000001012. Epub 2023 Jan 11.
Acute aortic syndromes include acute aortic dissection, intramural hematoma, and penetrating aortic ulcer, and are associated with high mortality and morbidity. This review focuses on recent findings and current understanding of gender-related and sex-related differences in acute aortic syndromes.
Large international and national registries, population studies, and multicentre national prospective cohort studies show evidence of sex differences in acute aortic syndromes. Recent studies of risk factors, aorta remodelling, and genetics provide possible biological basis for sex differences. The 2022 American College of Cardiology/American Heart Association Guidelines for the Diagnosis and Management of Aortic Disease revise recommendations for surgical management for aortic root and ascending aorta dilatation, which could impact outcome differences between the sexes.
Acute aortic syndromes affect men more frequently than women. The prevalence of acute aortic syndromes and prevalence of many risk factors rise sharply with age in women leading to higher age at presentation for women. Times from symptom onset to presentation and presentation to diagnosis are delayed in female patients. Females with type A dissection are also more commonly treated conservatively than male counterparts. These factors likely contribute to higher early mortality and complications in women.
急性主动脉综合征包括急性主动脉夹层、壁内血肿和穿透性主动脉溃疡，与高死亡率和高发病率相关。本综述重点关注急性主动脉综合征中与性别相关和与性相关差异的最新研究结果及当前认识。
大型国际和国家登记研究、人群研究以及多中心国家前瞻性队列研究显示了急性主动脉综合征存在性别差异的证据。近期关于危险因素、主动脉重塑和遗传学的研究为性别差异提供了可能的生物学基础。2022年美国心脏病学会/美国心脏协会主动脉疾病诊断和管理指南修订了主动脉根部和升主动脉扩张手术管理的建议，这可能会影响两性之间的结局差异。
急性主动脉综合征在男性中的发病率高于女性。急性主动脉综合征的患病率以及许多危险因素的患病率在女性中随年龄急剧上升，导致女性发病年龄更高。女性患者从症状出现到就诊以及从就诊到诊断的时间均延迟。A型夹层女性患者也比男性患者更常采用保守治疗。这些因素可能导致女性更高的早期死亡率和并发症。
