Sex Differences in Outcomes of Adults with Isolated Coarctation of Aorta

Background There are limited data about the effect (or lack thereof) of sex on clinical outcomes in adults with coarctation of aorta (COA). The purpose of this study was to compare atherosclerotic cardiovascular disease (ASCVD) risk profile, blood pressure (BP) data, echocardiographic indices, and mortality between men and women with COA. Methods Retrospective study of adults with COA, and no associated left-sided obstructive lesions, that received care at Mayo Clinic (2003-2022). ASCVD risk profile was assessed as the prevalence of hypertension, hyperlipidemia, type 2 diabetes, obesity, smoking history, and coronary artery disease. 24-hour BP monitor was used to assess daytime and nighttime BP and calculated nocturnal dipping. Results Of 621 patients with isolated COA, 375 (60%) and 246 (40%) were men and women, respectively. Women had similar ASCVD risk profile and daytime BP as men. However, women had less nocturnal dipping (7±5 versus 16±7 mmHg, p<0.001), higher pulmonary artery mean pressure (23 [16-31] versus 20 [15-28] mmHg, p=0.04), and higher pulmonary vascular resistance index (3.41±1.14 versus 3.02±0.76 WU*m2, p=0.006). Female sex was associated with all-cause mortality (adjusted hazard ratio [HR] 1.26, 1.04-1.94) and cardiovascular mortality (adjusted HR 1.38, 1.09-2.18). Conclusions Women had higher risk of cardiovascular and all-cause mortality compared to men. This may be related to the higher-than-expected ASCVD risk factors, abnormal nocturnal blood pressure, and pulmonary hypertension observed in women in this cohort. Further studies are required to identify optimal measures to address these risk factors.