TUNEL assay showed that apoptosis was significantly decreased in aortic valves of female RHD patients as compared to male patients (Fig 3A–3C), whereas no significant difference was found in the expression level of CASP3, CASP10, and H2A.X in aortic valves between male and female patients (S1 Fig). This evidence concerns the gene CASP3 and rheumatic heart disease.