Hypertensive cardiac remodeling in males and females: from the bench to the bedside.

Cardiovascular diseases affect women and men differently: there are sex-dependent differences in the age at which they become manifest, in the pathophysiologic consequences of various insults, in the relative importance of risk factors, and in the responses to several treatments (as reviewed recently).1,2 Although many of these differences may relate to modifications of the lipid profile, as well as differences in the functions of endothelial and/or vascular smooth muscle cells, it is becoming clear that direct actions within the heart itself must also be considered. The current review will, therefore, focus on sex-specific differences in the remodeling responses of cardiac ventricles to various challenges. At baseline, male and female hearts display several differences: (1) coronary artery size is smaller in women3; (2) there are differences in the electrophysiological properties of the hearts, as females have faster resting heart rates and longer rate-corrected QT intervals4,5; (3) male and female hearts differ in terms of the pattern of expression of certain genes6; and (4) there are differences in the contractile properties of male and female hearts.7,8 More importantly, there are significant differences in the way male and female hearts respond to various challenges. In rodents, aortic banding-induced pressure overload increases left ventricular mass to the same extent in males and females, but function is better preserved in females, and males show an early transition to heart failure.9,10 In rats, volume overload induces eccentric dilated hypertrophy in male Sprague–Dawley rats but not in females.11 Differences in the remodeling responses can also be seen after myocardial infarction (MI), because female rats develop less thickening of noninfarcted regions and less pronounced diastolic dysfunction than their male counterparts,12 and post-MI rupture of the left ventricle is less frequent in female than in male mice.13,14 …