Women are Prone to Age-Related aortic Stiffness

Aim To investigate sex differences in the aortic aging by analyzing aortic diameter and tortuosity in different segments of aorta across the age spectrum, using enhanced CT imaging. Method Between July 2021 and April 2022, a retrospective study screened patients with chest and abdomen contrast CT images. The outer edge-to-outer edge method was utilized to measure aortic diameters at five aortic levels, while arterial tortuosity of various segments was measured and calculated using imaging software. Mean values were compared at different age groups, including by sex, and correlation with age was determined. To validate the coherence of arterial elasticity and anticipated age-related arterial alterations, a subset of data from a previously published article in BMJ Open was extracted for the purpose of examining the correlation between age and arterial stiffness, stratified by sexes. Results 208 participants (56.6% men, mean age 60.13±16.33 years old, mean BMI 23.07±4.03 kg/m2, mean BSA 1.70±0.19 m2) were enrolled in this study. The BSA-adjusted aortic diameters showed a positive correlation with age in both sexes, but females demonstrated a more rapid increase in progressive aortic diameters throughout their lifespan than males. In the age groups of 60-69 and above 80 years old, males exhibited significantly larger L1 measurements than females. Conversely, in individuals over 80 years old, females displayed greater L3 values compared to their male counterparts. However, no sexual disparities were observed for L2, L4 and L5 across all ages. Females exhibited greater aortic tortuosity in the descending thoracic region compared to males across all age groups, whereas this sex-based distribution of aortic and abdominal tortuosity was only evident among individuals over 40 years old. The tortuosity of the aorta and descending thoracic aorta exhibits a marked increase with advancing age, particularly in females, while a non-significant linear correlation is observed between abdominal aortic tortuosity and age in both genders. BaPWV consistently increased with age in both males and females, but the increase was more significant in females. Although males initially had higher arterial stiffness, females surpassed them as they aged. Conclusion Patterns of vascular aging in aortic morphology differ between the sexes across the life course, with women experiencing more significant changes, especially in advanced age groups. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This word was supported by the National Natural Science Foundation of China (82200500), the Institutional Foundation of The First Affiliated Hospital of Xi'an Jiaotong University (2021ZYTS-01, 2021QN-03), and the Foundation of Key Research and Development Plan of Shaanxi Province of China (2023-YBSF-403). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: the Ethics Committee approval of the First Affiliated Hospital of Xi'an Jiaotong University. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets analyzed during the current study are available from the corresponding author on reasonable request.