Sex-Dimorphic Aging of Cardiovascular Disease Genes: A Network-Based Multi-Omics Analysis

Sex differences influence the incidence, timing, clinical presentation, and outcomes of cardiovascular disease (CVD), yet the molecular programs through which aging interacts with biological sex remain insufficiently understood. To address this gap, we integrated basal gene expression profiles from multiomics data across 981 donors and 17 CVD-relevant tissues with regulatory, genetic, network, disease-expression, and druggability information to characterize sex-dimorphic aging patterns in 1,176 candidate CVD genes. Using a two-step expression analysis, we identified 4,404 genes with significant age-associated expression trends (BH-FDR < 0.05), including 2,718 male-specific, 202 female-specific, and 742 shared trends. Concordant evidence across complementary statistical approaches highlighted 35 high-confidence sex-dimorphic genes, including REN, APOE, GUCY1A2, and SRD5A2. Regulatory analysis showed that most CVD genes were influenced by nearby genetic variants, with 96.2 Network-based analyses further suggested that CVD genes are organized within hierarchical biological structures, with curated protein-interaction data showing stronger geometric organization than broader interaction resources. Integration with Open Targets identified 289 genes already linked to approved drugs and 48 of the top 50 biomarker candidates supported by GWAS-eQTL colocalisation evidence. A final composite ranking prioritized NTRK1, TUBB4A, PTGS2, IL6, and PDE5A, and identified 19 actionable biomarkers supported by convergent expression, regulatory, genetic, and therapeutic evidence. Among these, a dedicated sex-specific evidence score nominated GUCY1A2, CACNA1D, PGR, PDE5A, and LEPR as the strongest candidates for sex-stratified validation, with GUCY1A2 and PDE5A converging on a nitric oxide-cGMP signaling axis. This study provides an integrative framework for discovering sex-dependent molecular signatures of cardiovascular aging and for prioritizing biologically supported, potentially actionable targets for precision cardiovascular medicine.