Adverse Cardiovascular Outcomes for Women—Biology, Bias, or Both?

In this issue of JAMA Cardiology, Ji et al¹ identify that starting at an early age, women have steeper increases in blood pressure than men throughout life, setting the stage for cardiovascular disease presenting differently, not simply later, in women than men. This introduces the concept that biology serves as an underpinning of sex differences in the pathophysiology of cardiovascular illnesses, in subsequent distinct pathophysiologic alterations, and in the variability in treatment effectiveness. The authors view blood pressure as the single most accessible metric of vascular aging as well as the largest contributor to ischemic heart disease and heart failure risk in both sexes.