Crosier Rebecca, Lopez Laporte Maria Agustina, Unni Rudy R, Coutinho Thais
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
CJC Open. 2023 Sep 15;6(2Part B):391-406. doi: 10.1016/j.cjco.2023.09.006. eCollection 2024 Feb.
The aorta plays a central role in the modulation of blood flow to supply end organs and to optimize the workload of the left ventricle. The constant interaction of the arterial wall with protective and deleterious circulating factors, and the cumulative exposure to ventriculoarterial pulsatile load, with its associated intimal-medial changes, are important players in the complex process of vascular aging. Vascular aging is also modulated by biomolecular processes such as oxidative stress, genomic instability, and cellular senescence. Concomitantly with well-established cardiometabolic and sex-specific risk factors and environmental stressors, arterial stiffness is associated with cardiovascular disease, which remains the leading cause of morbidity and mortality in women worldwide. Sexual dimorphisms in aortic health and disease are increasingly recognized and explain-at least in part-some of the observable sex differences in cardiovascular disease, which will be explored in this review. Specifically, we will discuss how biological sex affects arterial health and vascular aging and the implications this has for development of certain cardiovascular diseases uniquely or predominantly affecting women. We will then expand on sex differences in thoracic and abdominal aortic aneurysms, with special considerations for aortopathies in pregnancy.
主动脉在调节血流以供应终末器官和优化左心室工作负荷方面起着核心作用。动脉壁与保护性和有害性循环因子的持续相互作用，以及对心室动脉搏动负荷的累积暴露及其相关的内膜-中膜变化，是血管老化复杂过程中的重要因素。血管老化也受到氧化应激、基因组不稳定和细胞衰老等生物分子过程的调节。与既定的心脏代谢和性别特异性危险因素以及环境应激源同时存在的是，动脉僵硬度与心血管疾病相关，而心血管疾病仍然是全球女性发病和死亡的主要原因。主动脉健康和疾病中的性别差异越来越受到认可，并且至少部分地解释了心血管疾病中一些可观察到的性别差异，本综述将对此进行探讨。具体而言，我们将讨论生物性别如何影响动脉健康和血管老化，以及这对某些独特或主要影响女性的心血管疾病发展的影响。然后，我们将详细阐述胸主动脉瘤和腹主动脉瘤中的性别差异，并特别考虑妊娠期间的主动脉病变。
