Study finds sex among pulmonary hypertension risk factors
Women with PH tend to live longer than men, regardless of age, severity
Women with pulmonary hypertension have a lower risk of death than men, a difference that persists regardless of how severe the disease is, how old patients are, or how they are treated, a large study found.
The disparity mainly affected white patients, the researchers said.
“These insights provide new avenues for investigating underlying mechanisms and suggest including male sex as an independent factor in clinical risk assessment tools,” the scientists wrote.
The study, “Male survival disadvantage in pulmonary hypertension: independent of aetiology, age, disease severity, comorbidities and treatment,” was published in eBioMedicine by an international team of researchers.
Pulmonary hypertension is a disease in which pressure in the blood vessels of the lungs is abnormally high, putting strain on the heart and reducing oxygen delivery to the body’s tissues. While it affects both men and women, little is known about how sex influences survival.
Disparity persists across disease types
To compare survival between men and women with pulmonary hypertension, the researchers drew on the Pulmonary Vascular Research Institute (PVRI) GoDeep registry, which combines global data from other registries. Study data came from 21,123 patients who had complete hemodynamic (blood flow) measurements, meaning their heart and lung pressures were fully assessed.
Men had consistently higher rates of death than women across all types of disease: pulmonary arterial hypertension (PAH) and pulmonary hypertension caused by heart disease, lung disease, or blood clots, and mixed or unclassified types. Overall, the risk of death was 36% higher for men than for women.
Pulmonary vascular resistance (PVR) measures how difficult it is for blood to flow through the lungs. Patients were classified as having severe pulmonary hypertension if PVR exceeded 5 Wood units. Even with severe disease, women lived longer than men. For example, five-year survival for women with severe pulmonary hypertension was 56%, compared with 46% for men.
Women also had better survival across all ages, although the advantage was slightly less pronounced in younger patients (those aged 18–49), particularly those with PAH. Among white patients, the advantage persisted. However, in Black and Asian patients, survival was similar between men and women.
Most patients had reduced exercise capacity, measured by the six-minute walk distance test, and many also had obesity, heart disease, or chronic kidney disease. Despite these factors, women consistently had better survival, regardless of whether they were receiving treatment for pulmonary hypertension.
“These findings support the formal inclusion of male sex in [pulmonary hypertension] risk stratification tools,” the researchers wrote. “They also highlight the importance of developing sex- and race-sensitive management strategies to address disparities in [pulmonary hypertension] outcomes.”
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