Abstract
BACKGROUND: This study aims to investigate the influence of sex on age-related changes in aortic morphology using computed tomography (CT) imaging. METHOD: Patients who underwent contrast-enhanced chest and abdominal CT between July 2021 and April 2022 were enrolled and stratified into six groups. Sex-specific comparisons of body surface area (BSA)-adjusted aortic diameters and tortuosity were performed across different groups. To validate the consistency of sex differences on age-related arterial changes, particularly regarding stiffness, relevant data were extracted from a previously published study to analyze the correlation between age and arterial stiffness in both sexes. RESULTS: A total of 208 participants (59.6% males, overall mean age: 60.13 ± 16.33 years) were enrolled. The BSA-adjusted diameters showed a positive correlation with age in both sexes, with females exhibiting a more rapid increase than males. In the age groups of 60-69 years and above 80 years, females had significantly larger BSA-adjusted diameters of the ascending aorta than males. Additionally, after 40 years old, females had significantly greater BSA-adjusted tortuosity in all aortic segments than males. Both aortic and descending thoracic aortic tortuosity exhibited a notable increase with aging, particularly in females. Furthermore, branchial-pulse wave velocity (baPWV) showed a similar age-related progression pattern, with baPWV increasing at an accelerated rate in females. CONCLUSION: A sex-based variation in the rate of aortic morphological aging is observed throughout the lifespan, with females showing more pronounced changes in aortic tortuosity. It highlights the importance of prioritizing preventive measures for females, who may benefit more due to sex-specific disparities.