Table 1:

Examples of Sex Differences in Human CVD

Disease	Differential Sex Incidence	Sex-biased Characteristics		References
		Women	Men
Coronary artery disease	<50 yrs: incidence F<M; mortality F>M	Non-obstructive CAD, microvascular dysfunction. Stable plaques rich in smooth muscle cells, prone to erosion.	Obstructive CAD. Lipid-rich plaques, prone to bleeding and rupture.	3,8,9
	>50 yrs: F incidence increases
Takotsubo cardiomyopathy	F>M (9:1)	Transient reversible acute heart failure. Characterized by apical ballooning. Triggered by physical or emotional stress, changes in hormone levels.	Rare in men; more common in Japanese men than other ethnic groups.	10–12
Spontaneous coronary artery dissection (SCAD)	F>M (9:1)	Most common cause of pregnancy-associated MI (>40%). Characterized by extra-coronary vascular abnormalities. Triggered by physical or emotional stress, often without cardiovascular risk factors.	Rare in men.	13,14
Abdominal aortic aneurysm	Incidence F<M (1:5) rupture F>M	Diagnosed at later ages (protective effect of estrogen?). Increased rupture may be related to biomechanical properties of female aorta.	Occurs at earlier age than in women. Sex hormone signaling of renin-angiotensin-aldosterone system may promote male susceptibility.	15–18
Heart failure	HFpEF: F>M (2:1)	Heart failure with preserved ejection fraction (HFpEF) more common. Associated with non-ischemic disease, microvascular dysfunction, endothelial cell inflammation, altered nitric oxide signaling.	Heart failure with reduced ejection fraction (HFrEF) more common. Associated with ischemic heart disease and younger age of presentation.	19–22
	HFrEF: F<M (1:2)
Cardiac ischemic injury	<50 yrs: F<M	Better remodeling, decreased inflammatory cytokine production after ischemic heart injury in premenopausal women. However, estrogen replacement after menopause may increase incidence.	Lower cardiac tolerance to oxygen deprivation, reduced efficacy of cardiac remodeling.	23,24
	>50 yrs: F incidence increases
Aortic valve stenosis	F≠M presentation	Older at presentation. Characterized by sustained fibrosis.	Younger at presentation. Characterized by higher atherosclerotic burden and calcification.	25,26