For women and men, risk factors for cardiovascular disease are largely the same, a large global study involving the University of Gothenburg shows.
The study, now published in The Lancet, includes participants from high-, middle- and low-income countries. Cardiovascular disease is more widespread in the latter. The data was taken from the Rural Urban Prospective Epidemiological Study (PURE).
The study included 155,724 people in 21 countries, on five continents. Aged between 35 and 70 years, the participants had no history of cardiovascular disease when they joined the study. All cases of fatal cardiovascular disease, heart attack, stroke, and heart failure were recorded during the follow-up period, which averaged ten years.
The risk factors studied were metabolic (such as high blood pressure, obesity, and diabetes), behavioral (smoking and diet), and psychosocial (economic status and depression).
No clear gender or income division
Metabolic risk factors were found to be similar in both sexes, except for high low-density lipoprotein (LDL, often known as bad cholesterol) values, where the association with cardiovascular disease was stronger in men. However, in the opinion of the researchers, this finding needs confirmation in further studies.
Depressive symptoms were another risk factor for cardiovascular disease that was found to be more significant among men than women. On the other hand, the relationship between a poor diet and cardiovascular disease was stronger in women; and smoking, although markedly more common among men, was an equally detrimental risk factor for women.
Overall, the researchers found broadly similar cardiovascular disease risk factors for male and female participants, regardless of their country’s income level. This highlights the importance that disease prevention strategies are also the same for both sexes.
Similarities more than differences
Women’s overall lower risk of cardiovascular disease, especially heart attack (myocardial infarction), may be explained by younger women’s greater tolerance for risk factors. Its estrogen makes vessel walls more flexible and affects the liver’s ability to remove LDL.
Among the women in the study (90,934 people), there were 5.0 cases of stroke, heart attack and/or cardiovascular disease per 1,000 people per year. The corresponding number in the male group (64,790 individuals) was 8.2 cases.
Annika Rosengren, a professor of medicine at the Sahlgrenska Academy, University of Gothenburg, is the second author of the study, leading the Swedish part of the 4,000-person PURE population study in Gothenburg and Skaraborg.
When it comes to cardiovascular diseases in men and women, the similarities in terms of risk factors are considerably greater than the differences. But men are more vulnerable to high levels of LDL, the bad cholesterol, and we know from other studies that they develop pathological changes in their coronary arteries at a younger age than women, and they tend to start developing myocardial infarction much earlier . However, with regard to early stroke, the sex differences are less pronounced, as we have also seen in other studies.”
Annika Rosengren, Professor of Medicine at the Sahlgrenska Academy, University of Gothenburg
Walli-Attaei, M., et al. (2022). Metabolic, behavioral, and psychosocial risk factors and cardiovascular disease in women compared with men in 21 high-, middle-, and low-income countries: an analysis of the PURE study. the lancet doi.org/10.1016/S0140-6736(22)01441-6.
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