Aging of the aortic valve, characterized by leaflet thickening and loss of extensibility, leads to progressive changes in valve function. These age-related mechanisms have not been evaluated yet in sex-specific calcific aortic valve stenosis (CAVS) onset and progression. Recent studies reported the association between high aortic valve calcification (AVC) load and male gender in patients with CAVS while women present faster progression than men. To evaluate these age- and sex-specific differences, we performed a systematic review and meta-analysis with meta-regression.

A systematic search related to AVC measured by computed tomography and gender-specific differences was conducted according to PRISMA guidelines. Seven studies, enrolling 1859 men and 1055 women, were included in the quantitative synthesis.

We found a significant difference between men and women both in AVC load and density. AVC load mean difference (MD), between men and women, was 1131 ± 243 AU (p < 0.0001; I²: 96.5 %, p < 0.001), while AVC density MD was 159 ± 20 AU/cm² (p < 0.0001) without heterogeneity among the studies (I²: 23.5, p = 0.3). Meta-regression analyses showed that AVC load MD positively correlated with age and other cardiovascular risk factors such as diabetes, hypertension, and coronary artery disease presence.

Our meta-analysis shows a significant association of incremental AVC load with male gender, regardless of the individual anatomical characteristics and the cardiovascular risk factors. Further studies are needed: i) to clarify if there are different sex-related pathophysiological processes driving the development and the progression of age-related CAVS, and ii) to determine if a sex-specific therapeutic strategy should be applied for CAVS treatment and/or prevention.

主动脉瓣的衰老以小叶增厚和可延展性下降为特征，导致瓣膜功能的逐步改变。这些与年龄有关的机制尚未在性别特异性钙化主动脉瓣狭窄（CAVS）发作和进展中进行评估。最近的研究报道了CAVS患者的高主动脉瓣钙化（AVC）负荷与男性之间的关联，而女性的进展快于男性。为了评估这些年龄和性别差异，我们进行了系统的回顾和荟萃分析，并进行了荟萃回归分析。

根据PRISMA指南，对通过计算机断层扫描测量的AVC和性别差异进行了系统搜索。定量合成包括七项研究，分别招募1859名男性和1055名女性。

我们发现男性和女性在AVC负荷和密度上都有显着差异。男性和女性之间的AVC负荷平均差异（MD）为1131±243 AU（p <0.0001; I ²：96.5％，p <0.001），而AVC密度MD为159±20 AU / cm ²（p <0.0001 ）之间没有异质性（I ²：23.5，p = 0.3）。荟萃回归分析显示，AVC负荷MD与年龄和其他心血管危险因素（如糖尿病，高血压和冠状动脉疾病的存在）呈正相关。

我们的荟萃分析显示，无论个人的解剖特征和心血管危险因素如何，增加的AVC负荷与男性之间均存在显着相关性。需要进一步研究：i）阐明是否存在不同的性别相关病理生理过程来驱动与年龄相关的CAVS的发展和进程，以及ii）确定是否应将针对性别的治疗策略用于CAVS治疗和/或预防。