Aortic Stenosis in Women: Contemporary Perspectives and Lifetime Considerations

Overview

This review examines sex-based disparities in aortic stenosis (AS) across the disease continuum in women. Despite equivalent prevalence between sexes, women demonstrate delayed diagnosis, reduced specialist referral rates, lower intervention frequency, and worse survival outcomes. The pathophysiological mechanisms underlying AS in women and their myocardial compensatory responses differ from those in men, necessitating distinct diagnostic and hemodynamic assessment frameworks.

Methods and approach

The analysis synthesizes contemporary evidence regarding natural history trajectories, diagnostic approaches, and management strategies specific to women with AS. The review integrates data on sex-specific pathophysiological mechanisms, myocardial adaptation patterns, anatomical variations, and biological factors affecting disease progression and clinical presentation. Emphasis is placed on identifying gaps between current clinical practice and sex-tailored evidence-based approaches.

Key Findings

Women with AS exhibit distinct pathophysiological features and myocardial compensation mechanisms requiring tailored hemodynamic stratification and diagnostic protocols. Significant disparities persist in clinical care pathways, including prolonged diagnostic intervals, suboptimal specialist referral patterns, and reduced intervention rates despite comparable disease prevalence. These inequities correlate with inferior long-term survival outcomes in female patients. Biological, physiological, and anatomical considerations create additional complexity in lifetime disease management specific to women.

Implications

Sex-specific differences in AS pathophysiology and natural history necessitate revision of diagnostic criteria and hemodynamic thresholds to maintain diagnostic accuracy and optimize intervention timing in women. Implementation of systematically tailored investigational protocols and stratification algorithms designed for female physiology represents a critical clinical need to address current diagnostic delays and referral gaps. A lifetime, personalized management framework incorporating sex-specific considerations throughout the disease course is essential to align clinical outcomes in women with those of men and advance evidence-based practice standards.