Divergent mechanisms of cardiovascular remodeling between men and women

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality. Notably, there are significant differences between men and women in the manifestation, progression, and outcome of CVD, as well as in therapeutic responses. Overall, premenopausal women show greater protection against adverse remodeling. However, following menopause, women lose this advantage. It is, therefore, widely expected that sex hormones, particularly estrogen, play a major role, conferring females with protection, which might not necessarily be the case for males. In the present article, we elucidate pathways and biological processes affected by biological sex, that is, the renin-angiotensin-aldosterone system, oxidative stress responses, inflammation, endothelial function, microRNA regulation, and cell death. We conclude that more research on sex-biased mechanisms and interventions in CVD is necessary. Ultimately, these efforts will lead to the development of sex- and gender-informed guidelines for CVD prevention and treatment, thereby contributing to more equitable and effective cardiovascular care for all patients.