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Review
. 2020 Feb 21;21(4):1477.
doi: 10.3390/ijms21041477.

Sex/Gender-Specific Imbalance in CVD: Could Physical Activity Help to Improve Clinical Outcome Targeting CVD Molecular Mechanisms in Women?

Mauro Vaccarezza  1 , Veronica Papa  2 , Daniela Milani  3 , Arianna Gonelli  3 , Paola Secchiero  3 , Giorgio Zauli  3 , Donato Gemmati  4   5 , Veronica Tisato  3
Affiliations
Review

Sex/Gender-Specific Imbalance in CVD: Could Physical Activity Help to Improve Clinical Outcome Targeting CVD Molecular Mechanisms in Women?

Mauro Vaccarezza et al. Int J Mol Sci. .

Abstract

In the last two decades, new insights have been gained regarding sex/gender-related differences in cardiovascular disease (CVD). CVD represents the leading cause of death worldwide in both men and women, accounting for at least one-third of all deaths in women and half of deaths in women over 50 years in developing countries. Important sex-related differences in prevalence, presentation, management, and outcomes of different CVDs have been recently discovered, demonstrating sex/gender-specific pathophysiologic features in the presentation and prognosis of CVD in men and women. A large amount of evidence has highlighted the role of sex hormones in protecting women from CVDs, providing an advantage over men that is lost when women reach the menopause stage. This hormonal-dependent shift of sex-related CVD risk consequently affects the overall CVD epidemiology, particularly in light of the increasing trend of population aging. The benefits of physical activity have been recognized for a long time as a powerful preventive approach for both CVD prevention and aging-related morbidity control. Exercise training is indeed a potent physiological stimulus, which reduces primary and secondary cardiovascular events. However, the underlying mechanisms of these positive effects, including from a sex/gender perspective, still need to be fully elucidated. The aim of this work is to provide a review of the evidence linking sex/gender-related differences in CVD, including sex/gender-specific molecular mediators, to explore whether sex- and gender-tailored physical activity may be used as an effective tool to prevent CVD and improve clinical outcomes in women.

Keywords: CVD; clinical outcome; molecular mediators; physical activity; sex/gender differences.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Prevalence of insufficient physical activity as reported by WHO (https://www.who.int/gho/ncd/risk_factors/physical_activity/en/; data from 2016) in adults (aged 18+ years) and adolescents (11–17 years) stratified by sex and region.
Figure 2
Figure 2
Comparison of common sports engaged in according to sex in the US (data from the American Time Use Survey, https://www.bls.gov/spotlight/2008/sports/; The Bureau of Labor Statistics (BLS)).
Figure 3
Figure 3
Schematic representation of the most relevant mechanisms mediating cardiovascular (CV) responses/improvements due to physical exercise, which may help to establish differences between the sexes.
Figure 4
Figure 4
Snapshot of key differences in sex/gender features to be considered in physical activity to improve cardiovascular health, decrease cardiovascular disease (CVD) risk, and settle personalized training/rehabilitative exercise protocols.
See this image and copyright information in PMC

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