Sex-Specific Associations of Cardiovascular Risk Factors with Subclinical Cardiac Remodeling: A Magnetic Resonance Imaging Study.

Abstract

Background: Cardiovascular disease (CVD) is the leading cause of death in women, yet sex-specific risk factor influences remain understudied. Cardiac magnetic resonance imaging (CMR) detects early remodeling via left ventricular mass-to-volume ratio (LVMV), a validated concentricity marker. This study examines sex differences in the association of CV risk factors, diet, and cardiac remodeling.

Methods: We analyzed 622 age-matched adults (51% female, mean age 50.8 ± 9.5) from the Courtois Cardiovascular Signature Program. LVMV was defined as LV systolic mass divided by end-diastolic volume. Alcohol and sugar intake was self-rated on a Likert scale. Mann-Whitney U and regression analyses assessed sex-specific associations between CV risk factors and LVMV.

Results: Hypertension was present in 20.6% of males and 17.4% of females; diabetes in 9.8% and 6.0%. Males had higher triglycerides, alcohol/sugar intake, and LVMV (0.92 ± 0.20 vs. 0.77 ± 0.18 g/ml). Hypertension correlated with higher LVMV in both sexes (males: ß=0.099, p<0.001; females: ß=0.078, p<0.05), while triglycerides (ß=0.032, p<0.05) and alcohol intake (H=19.41, p<0.0001) were male-specific predictors. In females, diabetes and sugar intake were significantly associated with LVMV (ß=0.102, ß=0.062, p<0.05).

Conclusions: CV risk factors impact cardiac remodeling differently by sex. In males, LVMV was linked to triglycerides and alcohol intake, while in females, diabetes and sugar intake showed stronger associations. These results underscore the need for tailored cardiovascular prevention strategies that account for sex differences in metabolic and lifestyle risk factors.