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Background: Traditional risk factors insufficiently characterize the biological phenomena underlying sex differences in ventriculoarterial coupling (VAC). We hypothesize that sex differences in VAC are due to differences in left ventricular global longitudinal strain (LVGLS), a fuel-dependent chamber closely linked to mitochondrial fuel oxidation pathways.

Methods: Community older adults without cardiovascular disease were prospectively recruited for cardiac magnetic resonance imaging and concurrent serum metabolomics sampling. VAC was determined as aortic pulse wave velocity (PWV) divided by LVGLS. Multivariable models adjusted for clinical risk factors and metabolites.

Results: Among 202 participants (46.0% female), fewer women were smokers compared to men (3.2% vs 25.7% p<0.001). Despite similarities in age, (women: 69.7 vs men: 70.7 p=0.432) women had better VAC (-0.39 vs -0.47 p = 0.003 …