SALVAGE

The overarching objective of SALVAGE is to quantify the differences in vascular ageing and its association with hypertension (HTN) and cardiovascular diseases (CVD) between males and females, and to assess the role of gender related-factors. Objective 1 - To comprehensively compare the distribution of vascular ageing biomarkers including conventional (structural and functional) and novel (radiomics and wave analysis) biomarkers between males and females, and investigate the role of gender related factors at study recruitment. Objective 2- To comprehensively compare the association of vascular ageing biomarkers with prevalence and development of HTN and CVD events in males and females, and examine the role of gender related factors , as well as gender roles and relations . Objective 3 - To comprehensively compare the temporal change of vascular ageing biomarkers between males and females, and investigate the role of gender related factors Objective 4 - To conduct qualitative research on which gender roles and relations are relevant for vascular ageing and how to investigate them. The project will be conducted using data of a French (N=10,157, 40% women, age range 50 to 75 years) community-based prospective study coordinated by P1, the Paris Prospective Study 3 (PPS3, INSERM promotion), aiming to identify novel predictive biomarkers of CVD events. At baseline (2008-12), a series of structural and functional vascular ageing biomarkers were extracted from non-invasive high precision carotid echo tracking. A radiomic analysis is currently ongoing to extract features related to the texture, intensity and shape from the arterial images. Factors intimately related to gender including lifestyle, socioeconomic and mental health factors are available from baseline and in follow-up questionnaires every two years, over 12 years. A second clinical visit will take place between May 16th 2025 and December 31st 2027. This second visit will permit (i) to address the progression of vascular ageing as stated in objective 3 and (ii) to extend the exploration of gender roles by including gender norms and dimensions as stated in objective 4. This qualitative interview will permit identifying gender norms items to be included in the questionnaire at visit 2. All the regulatory and ethical requirements have been obtained (CPP agreement n°23.01485.000224-MS01 of 20/02/2025; National Commission for data privacy CNIL: n°924198 du 18/10/2024). The data for the first 2 objectives are readily available. The consortium includes 5 partners (including 2 foreign partners at no costs) with expertise in CVD epidemiology, arterial wall mechanics and gender in health prevention. They have been collaborating for more than 10 years in the framework of the PPS3 cohort, a European COST Action programme on vascular ageing (VascAgeNet) completed in 2024, and the Institute of women health and the Gender institute of Université Paris Cité. SALVAGE will have scientific impacts: it proposes an extensive methodological pipeline to investigate vascular ageing in a sex-disaggregated manner and to investigate the role of gender-related factors and gender dimensions, that may be applied by the scientific community in order to consider Gender as a Sociocultural Variable (GASV) as a complement to Sex as a Biological Variable (SABV) in research; this is a priority for research according to the European commission. SALVAGE will also have societal impacts: through the spectrum of vascular health, SALVAGE should contribute to increasing knowledge of different stakeholders including the general population, the students, the academics, the policy makers and the scientific bodies on the presence of sex (i.e biological) and gender (i.e societal norms) disparities in vascular health.