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Canadian Journal of Cardiology

Sex Considerations in Aneurysm Formation, Progression, and Outcomes

  • Kevin E. Boczar
    Affiliations
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
    Search for articles by this author
  • Thais Coutinho
    Correspondence
    Corresponding author: Dr Thais Coutinho, Division of Cardiac Prevention and Rehabilitation, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, Ontario K1Y 4W7, Canada. Tel.: +1-613-696-7397; fax: +1-613-696-7133.
    Affiliations
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

    Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

    Canadian Women's Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
    Search for articles by this author
Published:January 23, 2018DOI:https://doi.org/10.1016/j.cjca.2017.12.031

      Abstract

      Aneurysm formation is a complex multifactorial process with both genetic and environmental influences. Over recent years, there has been increasing recognition of sex-specific differences regarding the prevalence and natural history of cardiovascular diseases in the population. In particular, there is a growing body of evidence showing that aneurysm behaviour differs based on sex. Although most types of aneurysms are more common in men, their growth rates and outcomes are worse in women. This fact raises attention about potential underlying differences in the arteries of men and women that may contribute to differences in aneurysm prevalence and outcomes. There are complex biochemical and mechanical mechanisms at play that contribute to vascular health. Furthermore, many studies have suggested potential differences in the hormonal milieu and underlying arterial anatomy between men and women. Based on the data reviewed in this article, assessment of the underlying pathophysiology of aneurysms in women might prove clinically useful regarding prevention, early detection, and management of aneurysms in women. Sex-specific research, screening, and treatment guidelines for aneurysm disease should be introduced to reflect the differing natural history of these diseases in men and women.

      Résumé

      La formation des anévrismes est un processus multifactoriel complexe qui est influencé par la génétique et l’environnement. Au cours des dernières années, on a pris de plus en plus conscience des différences qui existent entre les sexes concernant la prévalence et l’évolution naturelle des maladies cardiovasculaires dans la population. Notamment, il existe un nombre sans cesse croissant de données probantes qui montrent que le comportement des anévrismes diffère selon le sexe. Bien que la plupart des anévrismes soient plus fréquents chez les hommes, leurs taux de croissance et leur évolution sont pires chez les femmes. Ce fait suscite l’attention sur les différences sous-jacentes potentielles entre les artères des hommes et des femmes qui peuvent contribuer aux différences dans la prévalence et l’évolution des anévrismes. Il existe des mécanismes biochimiques et mécaniques complexes qui contribuent à la santé vasculaire. De plus, plusieurs études ont démontré des différences potentielles du milieu hormonal et de l’anatomie artérielle sous-jacente entre les hommes et les femmes. Selon les données passées en revue dans le présent article, l’évaluation de la physiopathologie sous-jacente des anévrismes chez les femmes pourrait s’avérer utile sur le plan clinique pour ce qui est de la prévention, de la détection précoce et de la prise en charge des anévrismes chez les femmes. La recherche, le dépistage et les recommandations de traitement de la maladie anévrismale selon le sexe devraient être réalisés pour faire ressortir les différences dans l’évolution naturelle de ces maladies entre les hommes et les femmes.
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