Sex-Specific Growth Rates of Ascending Thoracic Aortic Aneurysms in Non-Syndromic Patients: A Systematic Review

TL;DR

This study reviews whether non-syndromic females have different aortic aneurysm growth rates compared to males, finding mixed evidence.

Contribution

The paper provides a systematic review of sex-specific aTAA growth rates in non-syndromic patients with normal aortic valves.

Findings

Three of five included studies found faster growth rates in females.

Female growth rates ranged from −0.7 to 1.74 mm/year.

Limited data and high heterogeneity led to inconclusive results.

Abstract

Background/Objectives: Ascending thoracic aortic aneurysms (aTAAs) pose a high risk of dissection and rupture. Though more prevalent in males, females may experience worse outcomes. Growth rate is considered a part of risk assessment, yet data in non-syndromic females without valve abnormalities remain limited. This study aims to assess whether aTAA growth differs between non-syndromic females and males with normal aortic valve morphology. Methods: The systematic review followed the PRISMA 2020 guideline. The final search was completed in April 2025, with guidance from a certified librarian. Included studies were RCTs or observational studies of non-syndromic adults with aTAA reporting sex-specific data and included ≥10 females. Prior dissection, valve replacement, or surgery were excluded. In addition to the original search, 11 articles were identified as likely to contain sex-specific data, and the corresponding authors were contacted. The protocol is registered in PROSPERO (CRD420251025890). Meta-analysis was not performed due to high heterogeneity and limited study numbers. Results: Of 2629 identified studies, 73 studies were screened in full-text, and only three met the inclusion criteria. The most common exclusion reason was lack of appropriately sex-stratified data. Two authors out of the 11 contacted replied with additional datasets, resulting in a total of five studies being included. Of the five included studies, three found faster growth rates in females. Reported growth rates in females varied notably, ranging from −0.7–1.74 mm/year. Conclusions: Evidence on sex differences in aTAA growth among non-syndromic patients with normal aortic valves remains inconclusive. Three of the five studies reported faster growth in females. Standardization in future research is needed.

Figures