Gender Differences in Aortic Stenosis
What is Aortic Stenosis
The heart has several valves that prevent blood from being pumped in the wrong direction. These valves basically act as gates. There is an important valve between the aorta, which is the main outflow of the heart, and the left ventricle chamber, which is termed the “aortic valve”. Sometimes this gate which lets blood to leave out of the heart, does not open fully due to narrowing. This is termed as “stenosis” or specifically “aortic valve stenosis”. Aortic stenosis is an emerging problem in the developed world, due to an aging population.
What are its Complications?
Since the blood output from the heart is impaired, blood collects and builds up in the left ventricle. To push blood out, the heart wall reacts by getting bigger and more robust which we call “hypertrophy”. A hypertrophic heart may predispose to a heart attack later. The left ventricular and left atrial chambers may dilate. Sometimes it may even affect the lung as well. The classical symptoms are fainting, chest pain and shortness of breath.
How does Aortic Stenosis Differ between Males and Females?
Men and women are physiologically different and thus the effects of disease may be different as well. Women have lower aortic valve weight and lower aortic valve calcium. More calcium correlates with more stenosis.
Based on the prevalence of aortic stenosis, men and women present with the disease equally. The main difference is that women are diagnosed at later ages than men, thus they have less favorable outcomes. At equal severity of stenosis, women have more clinical symptoms and higher left atrial volumes. If we take equal ages, women with severe aortic stenosis incur higher mortality than men.
With regard to the corrective procedure for aortic stenosis, there are two main options: surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). Transcatheter valve replacement is done via a catheter inserted to a blood vessel. SAVR is known to present a greater risk to women than men, while TAVR has a low risk in women compared to men.
One special attribute is that aortic stenosis is thought to be a primarily male disease. Therefore, as a result of that, females tend to be referred less for follow up. At presentation, women with aortic stenosis show higher frequency of hypertension, whereas coronary artery disease and atherosclerosis is more frequent in men. Hypertrophy due to aortic stenosis is more concentric if you look at the section of the left ventricle in women, while it is more eccentric in men.
If you have any symptoms such as fainting, chest pain and shortness of breath, contact your doctor for examination and investigations. They will use an imaging technique called an echocardiogram to visualize your aortic valve and see how stenosis has affected your heart. After a diagnosis, they will decide your mode of treatment depending on your pre-existing conditions. Contact your doctor or contact us at The Valve Clinic to find out your options.
- ‘Roberta Ancona’ ‘. Epidemiology of aortic valve stenosis (AS) and of aortic valve incompetence (AI): is the prevalence of AS/AI similar in different parts of the world? Escardio.org. https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/epidemiology-of-aortic-valve-stenosis-as-and-of-aortic-valve-incompetence-ai. Published 2021. Accessed November 25, 2021.
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- Thaden J, Nkomo V, Suri R et al. Sex-related differences in calcific aortic stenosis: correlating clinical and echocardiographic characteristics and computed tomography aortic valve calcium score to excised aortic valve weight. Eur Heart J. 2015;37(8):693-699. doi:10.1093/eurheartj/ehv560