Sex Differences and Similarities in Valvular Heart Disease

Abstract

As populations age worldwide, the burden of valvular heart disease has grown exponentially, and so has the proportion of affected women. Although rheumatic valve disease is declining in high-income countries, degenerative age-related causes are rising. Calcific aortic stenosis and degenerative mitral regurgitation affect a significant proportion of elderly women, particularly those with comorbidities. Women with valvular heart disease have been underrepresented in many of the landmark studies which form the basis for guideline recommendations. As a consequence, surgical referrals in women have often been delayed, with worse postoperative outcomes compared with men. As described in this review, a more recent effort to include women in research studies and clinical trials has increased our knowledge about sex-based differences in epidemiology, pathophysiology, diagnostic criteria, treatment options, outcomes, and prognosis.

Keywords: aortic valve; clinical trial; epidemiology; heart valve diseases; mitral valve; prognosis; sex characteristics.

Figure 1.

CENTRAL ILLUSTRATION: Sex Differences in Valvular Heart Disease

Figure 2.

Age- and Sex-Specific Global Prevalence of Three Forms of Valvular Heart Disease

Figure 3:

Sex-Based Differences in Survival after Interventions for Aortic Stenosis A) Survival after Transcatheter Aortic Valve Intervention Survival following Transcatheter Aortic Valve Intervention among patients with and without pulmonary hypertension in FRAILTY-AVR B) Survival among patients with at least Mild-to-Moderate AS Survival among patients with at least mild-moderate AS in single-center from Canada. IPW-HR, inverse-probability weighted hazard ratio C) Survival after Surgical Aortic Valve Replacement Sex-Differences in Survival following Surgical Aortic Valve Replacement After Propensity Score Matching in the Multicenter Spanish Aortic Valve Registry

Figure 4.

Valvular Heart Disease in Pregnancy^{, , ,}

Figure 5.

Sex-Based Differences in Outcomes after Interventions for Mitral Regurgitation A) Mitral Valve Surgery for Ischemic Mitral Regurgitation Sex-Differences in All-Cause Mortality following Mitral Valve Surgery for Severe Ischemic Mitral Regurgitation in the Cardiothoracic Surgical Trials Network B) Transcatheter Edge-to-Edge Repair Sex-Differences in Heart Failure Hospitalizations following Transcatheter Edge-to-Edge Repair in the COAPT trial C) Surgical Mitral Valve Repair Sex-Differences in Survival Following Surgical Mitral Valve Repair in Medicare Beneficiaries