Impact of Sex on Cardiovascular Adaptations to Exercise: JACC Review Topic of the Week (JACC September 2023-1)-Article: Impact of Sex on Cardiovascular Adaptations to Exercise: JACC Review Topic of the Week

Article: Impact of Sex on Cardiovascular Adaptations to Exercise: JACC Review Topic of the Week

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This JACC review assesses how sex differences impact cardiovascular adaptations to exercise in athletes. Key points include:<br /><br />1. **Cardiovascular Adaptations by Sex**: Exercise induces distinct cardiovascular remodeling in males and females, evidenced by variances in electrocardiograms (ECGs) and cardiac imaging. These adaptations also echo general population differences.<br /><br />2. **Research Gaps and Underrepresentation**: Historically, female athletes have been underrepresented in cardiovascular research, leaving gaps in understanding these sex-based differences. Increased female sports participation in recent decades necessitates new research to distinguish biological from societal factors.<br /><br />3. **Electrocardiogram Differences**: Female athletes generally exhibit fewer ECG changes than males but are more likely to show “abnormal” anterior T-wave inversions, which might not indicate structural heart disease.<br /><br />4. **Imaging Differences**: Female athletes have smaller left and right ventricular sizes and thicker left ventricular walls compared to males. This difference, however, normalizes when adjusted for body surface area, except for LV mass which remains smaller.<br /><br />5. **Female Protective Effects**: Female sex appears protective against several exercise-related cardiovascular risks, including coronary artery calcification, myocardial fibrosis, atrial fibrillation, and sudden cardiac death.<br /><br />6. **Hormonal Influences**: Sex hormones significantly affect cardiovascular function and exercise capacity. Testosterone in males enhances performance, whereas estrogen impacts cardiac structure and function in females. The effects of menstrual cycles, oral contraceptive pills, and hormonal fluctuations during menopause on cardiovascular performance require more research.<br /><br />7. **Pregnancy and Exercise**: Exercise during pregnancy is beneficial, but optimal exercise guidelines and safe postpartum return to competitive sports are areas needing further study.<br /><br />8. **Transgender Athletes**: Gender-affirming hormonal therapy influences performance, with data suggesting declines in athletic performance among transgender females. More research is needed to understand these impacts fully.<br /><br />The review concludes that more equitable representation in research is essential to accurately understand and address sex-specific cardiovascular adaptations and outcomes related to exercise, benefiting both athletes and the general population.

Keywords

sex differences

cardiovascular adaptations

athletes

ECG changes

cardiac imaging

female underrepresentation

hormonal influences

pregnancy and exercise

transgender athletes

research gaps