Gender Disparities in Valvular Heart Disease and Treatment in the Aging Population

As the presence of valvular heart disease increases with age and women have a longer life-expectancy than men, gender disparities for patients with valvular heart disease (VHD) are exacerbated in the aging population. In this article, we review the differences in presentation, pathophysiology, treatment, and outcomes between men and women with VHD and examine available data as to how these differences may impact the aging population.

Available data demonstrate significant gender-related differences in clinical presentation, treatment, and outcomes for patients with valvular heart disease (VHD). It is also well-established that men and women exhibit different risk profiles which leads to a significant impact on treatment outcomes. Women tend to be under-referred, often present for delayed treatment, and are under-represented in most large-scale clinical trials.

Valvular heart disease is a major contributor to cardiovascular morbidity and mortality in women—the leading cause of mortality in women worldwide. Many studies demonstrate anatomic and pathophysiologic gender differences in the structure and function of aortic and mitral valve disease processes. These differences are not incorporated in current ACC/AHA guidelines for diagnosis and management of aortic and mitral disease, which leads to the under-diagnosis and undertreatment of VHD in women. As a result, women present later in the disease process and experience increased risk for VHD-related events and increased morbidity and mortality with surgical and percutaneous interventions. These sex specific differences are likely to be amplified in older adults, as women compose a greater proportion of the aging population with increased life expectancy compared to men.