Sex Differences in Cardiovascular Health and Disease
Summary
Sex exerts a profound influence on cardiovascular health from epidemiology to molecular mechanisms. Across the lifespan, women and men display distinct patterns of risk factor prevalence, clinical presentation and outcomes. Before midlife, oestrogen confers relative protection in women, delaying atherosclerotic changes and preserving endothelial function, whereas post-menopausal oestrogen decline accelerates vascular stiffening and left ventricular remodelling. Men, by contrast, develop coronary artery disease earlier and exhibit a higher incidence of myocardial infarction in middle age. In heart failure, women more often present with preserved ejection fraction and concentric hypertrophy, whereas men more frequently develop reduced ejection fraction with dilated ventricles. Biomarker profiles differ by sex, with women tending towards higher natriuretic peptides and inflammatory mediators and men showing elevated troponins. Such differences reflect variations in body composition, hormonal milieu, gene expression and immune responses, notably pathways of neutrophil degranulation and immunomodulation. Recognition of these sex-specific trajectories is vital to optimise screening, refine diagnostic thresholds, tailor therapy and reduce disparities in global cardiovascular outcomes.
Research from Nature Portfolio
Recent analyses of subclinical myocardial function have revealed that age-related decline in global longitudinal strain (GLS), an indicator of longitudinal deformation, is pronounced in women but not in men. In a cohort with normal left ventricular ejection fraction, women aged 66 years and older demonstrated a significantly higher risk of reduced GLS, suggesting an early marker of subclinical dysfunction in older females. These findings underscore the value of strain imaging for sex-specific risk stratification beyond conventional ejection fraction measures.
Sex Differences in Cardiovascular Health and Disease publication trend
The graph below shows the total number of articles in sex differences in cardiovascular health and disease across all publications each year (not limited to Nature Index journals).
Technical terms
Global longitudinal strain (GLS): A measure of myocardial deformation along the long axis, used to detect subclinical ventricular dysfunction before ejection fraction declines.
Left ventricular ejection fraction (LVEF): The percentage of blood volume expelled from the left ventricle with each heartbeat, a standard index of systolic function.
Proteomics: The large-scale study of proteins expressed in biological systems, often using multiplex assays to identify disease-related pathways.
Neutrophil degranulation: The release of granule-stored enzymes and signalling molecules from neutrophils, contributing to inflammation and tissue remodelling.
Natriuretic peptides: Hormonal markers released by cardiac myocytes in response to stretch, involved in fluid regulation and used as biomarkers for heart failure.
References
- Clinical and Proteomic Risk Profiles of New-Onset Heart Failure in Men and Women. JACC Heart Failure (2024).
- Sex-based differences in cardiovascular proteomic profiles and their associations with adverse outcomes in patients with chronic heart failure. Biology of Sex Differences (2023).
- Sex differences in cardiac remodeling post myocardial infarction with acute cigarette smoking. Biology of Sex Differences (2022).
- Sex difference in the age-related decline of global longitudinal strain of left ventricle. Scientific Reports (2023).
Turn complex research questions into confident strategic decisions
When you're under pressure to set direction, justify investment, or understand your competitive position, you need more than raw data — you need trusted insights you can act on.
Benchmark your performance against global peers using robust, methodologically sound analysis.
Combine quantitative metrics with qualitative expert insight to uncover strengths, gaps and emerging opportunities.
Gain tailored, decision-ready recommendations aligned to your strategic priorities.
Talk to us to learn more about our data dashboards and bespoke strategy reports.
Grow research skills, confidence and careers with training built for every stage of the research lifecycle.
Developed with Nature Portfolio journal Editors and internationally renowned experts. Discover three ways to learn:
Self-paced, online courses in convenient bite-sized units, covering key skills across scientific writing, publishing, grant writing, data analysis, and more.
Expert trainer-led workshops with hands-on exercises and real-time feedback across core research skills, delivered via interactive group sessions.
Editor-led workshops combining core principles in writing and publishing, personalised 1:1 feedback from Nature Portfolio Editors and hands-on exercises.
Explore course catalogues and workshop agendas, enquire about the options or request institutional pricing.