Sex- and Gender-Related Aspects in Pulmonary Hypertension

Females are more affected by PAH compared with males. Despite female patients with PAH having a higher WHO functional class, male PAH patients have a more impaired RV function and hemody-namics compared with females with PAH. For this reason, males affected by PAH have poorer outcomes than females. The effects of estrogens and other sex hormones on the pulmonary vascu-lature and RV are complex yet highly fascinating because of their direct relevance to clinical mani-festations of various forms of PAH. Beyond sex (biological-based) differences, the interplay between gender domains and PAH has been only partially studied. PAH has a significant impact on daily lives of patients and caregivers. It generates changes in many social roles such as at work (eg, reduction in the job efficiency) and within the family (limited activities as parent or partner). Social isolation affects the QOL of both PAH patients and their careers, resulting in the loss of social roles that patients once held. As patients with PH feel like having an "invisible" disease, lacking the understanding by patients' social network, psychological support should be offered according to guidelines. In fact, emotional support can help to improve the outcome of PAH. Finally, differences in society and opportunities can relate with gender identity, in particular for individuals that are often discriminated such as transgender people. Lower SES and incomes are associated with different etiologies, a delay in diagnosis and treatment, a more severe disease at first visit, and therefore a raise in mortality and a worse prognosis. Even the educational level might play an important role, despite not being still clearly investigated in the literature. Further studies, aimed at understanding the mechanisms behind the observed sex-and gender-based differences in PAH, may inform the development of novel tailored and personal-ized approaches for the management of PAH patients.