Patient specific insights into thoracic aortic disease: Exploring male-female differences

There are clear differences between males and females with thoracic aortic aneurysms (TAA). For starters, thoracic aortic aneurysm (TAA) between is known to have a higher incidence in males. Furthermore, females seem to present with thoracic aortic aneurysm at an older age. However, little is known about possible differences between male and female TAA patients in presentation, management and outcomes. Worse outcomes in females after thoracic aortic dissection and elective thoracic aortic surgery have been reported, which lead to uncertainties about optimal timing of preventive thoracic aortic surgery in male and female patients. The mechanisms underlying these male-female differences in outcome remain unclear. As a result, there has been debate about the appropriateness of the use of absolute aortic diameter for the timing of surgery. Currently, sex and body size are not taken into account when timing preventive aortic surgery. However, male-female specific cut-off values for maximal aortic diameter might be helpful. Furthermore, the risk of aortic dissection causes stress and anxiety in TAA patients, which could impact quality of life. The effect of TAA on quality of life might be different in males and females, since male-female differences in emotional functioning, coping strategies and stress (i.e. anxiety/depression) are well known to exist in the general population. Moreover, limited information is available on the safety of daily activities, such as exercise and sports participation in both male and female patients with thoracic aortic disease. All these male-female differences have largely been neglected in patients with heart disease in general and aortic disease in particular. Therefore, research in all these aspects of aortic disease is essential. This thesis is part of the ‘Size Matters’ project, funded by ZonMW, aims to identify male-female differences and other patient specific insights into thoracic aortic aneurysm diagnosis, treatment and outcomes. More accurate identification of patients at risk for thoracic aortic dissection allows for better timing of intervention, and will hopefully contribute to better survival, as well as stress reduction and better quality of life.