Contemporary Issues in Cardiology Practice Vascular Aging in Women

Well-established cardiometabolic and sex-specific risk factors affect vascular health across a woman's lifespan and modulate lifelong risk for cardiovascular disease (CVD), which remains the #1 killer of women worldwide. CVD remains understudied and under-recognized in women. In this brief review, we describe the process of vascular aging, highlighting the impact of biological female sex and female sex hormones on arterial stiffening and endothelial dysfunction. We summarize the vasculoprotective effects of estrogen in premenopausal women and explore the role of the menopausal transition and the autonomic nervous system on accelerated vascular aging seen in older women. Finally, we will review the vascular effect of female-specific conditions, including polycystic ovarian syndrome and adverse pregnancy outcomes, such as pre-eclampsia.