The Estrogen Puzzle in Pulmonary Arterial Hypertension
The biology of Pulmonary Arterial Hypertension (PAH) is full of mysteries and one of its longer standing ones has also intrigued and inspired both scientists and artists throughout history: the female sex. While affecting patients of all ages and both genders, PAH preferentially affects young women, suggesting that the female gender is a risk factor for PAH. Even in heritable PAH (HPAH) associated with autosomal dominant mutations in the gene encoding the bone morphogenetic protein receptor type 2 (BMPR2), women after puberty are about 2.5 times more likely to develop PAH than males1. In idiopathic PAH (IPAH) the female/male ratio ranges from 1.7:1 or 1.9:1 to 4.1:1 in three published PAH registries (the NIH registry in the 80s2, the French registry3 and the REVEAL registry4 respectively). On the other hand, the disease can be more severe in men. Female animals with PAH tend to have lower pulmonary artery pressures and better outcomes compared to males5 and similarly, male PAH patients have higher mortality than females6. The basis for this apparent paradox remains unknown. (SELECT FULL TEXT TO CONTINUE)
- Received July 24, 2012.
- Accepted July 27, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited