Heart failure & cardiomyopathiesCohort study

Sex Differences in Age-Associated Concentric Remodeling and Diastolic Dysfunction

JACC AdvPublished

  • cohort
  • covariate-adjusted general linear models
  • sensitivity analysis on a subgroup free of comorbidities

Authors' conclusion

The age-associated cardiac remodeling and reduced diastolic function in older females were independent of comorbidities, supporting intrinsic sex-specific differences in cardiac aging emerging after the menopausal transition. These findings support the development of precise, sex-specific prevention strategies.

Study context

Population
Individuals with echocardiographic assessment of left ventricular geometric remodeling and diastolic functionfemales/males: 18,476/23,601, sensitivity subgroup free of comorbidities N = 14,250 · females 18,476 · males 23,601
Participants
42,077 individuals
Exposure
Age-associated differences in echocardiographic parameters between sexes
  • femalesn = 18,476
  • malesn = 23,601

Main finding

As reported in the abstract

Age-by-sex interaction for all key parameters

Significant age-by-sex interactions for all key parameters with covariate adjustment

P < 0.001

Observational data: associations, not effects.

Further findings

Relative wall thickness · after age 60

Marked rise in relative wall thickness in females after age 60 (interaction F)
F = 18.88
Females demonstrated increased age-related interventricular septal thickening and left ventricular end-diastolic diameter decline, indicating a shift toward concentric remodeling

e' velocity and E/e' ratio · from the sixth decade

e' velocity decreased significantly and E/e' ratio increased significantly in females from the sixth decade
F = 26.32

Left atrial volume index and tricuspid regurgitation pressure gradient

Older females exhibited larger left atrial volume index and higher tricuspid regurgitation pressure gradients

Composite z-score of diastolic function parameters · sixth decade

Significant sex-specific disparities, sixth decade as the age of marked divergence in diastolic function
F = 36.86

Sensitivity analysis in individuals without comorbidities

These patterns persisted in the subanalysis of individuals without comorbidities
  • subgroup N = 14,250

Original publication

Sex Differences in Age-Associated Concentric Remodeling and Diastolic Dysfunction. JACC Adv. Published 1 April 2026. doi:10.1016/j.jacadv.2026.102682

Summarised from the published abstract; every number is checked against it