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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Article info
Publication history
Published online: January 23, 2018
Accepted:
December 24,
2017
Received:
October 2,
2017
Footnotes
See page 368 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
