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 Change Of Heart: Men’s, Women’s Hearts Age Differently


When it comes to matters of the heart, men and women age differently, according to a study recently published online in the journal Radiology. These findings suggest that gender-tailored treatments may be needed for age-related heart failure. 

Heart failure affects more than 5 million Americans, according to the American Heart Association. To determine who develops heart disease or heart failure, what factors cause the disease, and who is more prone to die from it, a federally funded longitudinal study called MESA (Multi-Ethnic Study of Atherosclerosis) is following nearly 7,000 American men and women of four ethnicities—white, black, Latino, and Asian. The current study is an offshoot from this main study. 

“The shape of the heart changes over time in both men and women, but the patterns of change are different. Men’s hearts tend to get heavier, while women’s hearts tend to get smaller,” said study author John Eng, MD, from Johns Hopkins University School of Medicine in Baltimore.

Eng and his group followed via magnetic resonance imaging (MRI) scans the changes of the hearts of nearly 3,000 older American adults who started without heart disease. Participants underwent another MRI about 10 years later, when they were aged 54 to 94 years. In the interim, study subjects answered questionnaires that assessed smoking history, exercise habits, medication use, and physician diagnoses of high blood pressure and diabetes. They also had their blood pressure, glucose, triglycerides, and cholesterol levels measured and analyzed.

Although previous studies using ultrasound have tracked heart changes over time, MRI scans provide researchers with 3-D and more detailed images of the heart’s interior and exterior. Now, researchers can more accurately determine the heart’s size, volume, and weight—and find out what makes the ticker tick.

During those 10 years, the weight of the left ventricle—the heart’s chamber that pumps blood throughout the body—increased by an average of 8 grams in men and decreased by 1.6 grams in women.  The heart’s filling capacity—the amount of blood the left ventricle holds between heartbeats—declined in both sexes, but more so in women, by about 13 milliliters, than in men (10 milliliters). 
These observed differences occurred independently of other heart disease risk factors, such as body weight, blood pressure, cholesterol levels, exercise levels, and smoking. Race also did not appear to be a factor, explained Eng, as no differences were found among the groups.

Eng offers one possible explanation for this gender bender: differences in scarring, or fibrosis, of the heart, a natural aging process in which heart muscle cells, sarcomeres, are replaced with fibroid cells, fibroblasts.

Heart failure is characterized by the gradual weakening of the heart muscle and the eventual loss of its pumping ability. The heart also grows in size, and its pumping chambers, the ventricles, thicken from having to overexert themselves to pump blood due to high blood pressure, among other factors.

Cardiologists often prescribe medications to control high blood pressure, reduce the heart’s workload, and boost cardiovascular performance. These may reduce the thickness of heart muscle over time.
However, this study’s finding that women’s hearts tend to shrink means that they may not derive the same benefit from such treatments and that the optimum combination of medications may be different in women, said Eng.
“We’ve been talking a lot lately about personalized/precision medicine,” he said. “Here’s an example where perhaps men and women might have to be treated differently.”

Jackie Oberst is Provider’s managing editor. Email her at or follow the magazine on Twitter @ProviderMag or @ProviderMyers.

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