Evidence demonstrating bidirectional communication between the heart and brain is accumulating. Growing evidence shows that gender impacts heart–brain interactions in cardiac and brain diseases. Rossi et. al. discuss sex-based differences in several common conditions.
Techniques including computed tomography, positron emission tomography, single-photon emission computed tomography, and diffusion and perfusion magnetic resonance imaging have demonstrated higher global and regional perfusion of both heart and brain in women than in men.
Men exhibit higher baseline sympathetic nervous system activity than women. Women exhibit higher parasympathetic activity than men. This difference declines in post-menopausal women. This means that older women typically have increased sympathetic and less parasympathetic nervous system activity than younger women.
Women tend to have higher levels of inflammatory markers and pro-inflammatory cytokine production than men.
Ischaemic heart disease (IHD)
Although mortality from IHD has been decreasing, the decline in women has been less than in men. Women experiencing ST-elevation myocardial infarction (STEMI) have higher rates of mortality than men with STEMI.
Heart failure (HF)
Women with HF are usually older than men with HF, and have better outcomes. Women will more commonly have a preserved ejection fraction (EF); men, a reduced EF. Testosterone stimulates the renin-angiotensin activating system; estrogens attenuate it.
Takotsubo syndrome (TTS)
The prevalence of TTS is higher in women, especially post-menopausal women. Sympathetic hyperactivity and microvascular dysfunction, both found in TTS, are predictive of major adverse cardiovascular events in women but not in men.
Stroke
The risk of stroke increases in women after menopause. Stroke due to atrial fibrillation is more common in women than in men. Stroke outcomes are more favourable in men than in women.
Depression
There is a 2:1 rate of depression in women to men. Concurrent cardiac comorbidities are three times more likely in depressed people than in people with no mood disorders.
Dementia
Women are twice as likely to be affected by dementia than men.
Gender related differences impact cardiac and brain diseases
Vascular, neurohormonal and immune system differences between the sexes can significantly influence the course, impact and outcome of several cardiac and brain diseases. Further research into these mechanisms is warranted to inform more precise and effective management strategies.
For more cardiology research news join our newsletter or follow us on Twitter, Facebook, LinkedIn or Instagram.
Author: Kelly Schoonderwoerd
Original article: Rossi et. al. Eur Heart J. 2022 Feb 23; 1-14.
