Preventive Cardiology
Gender-Related Cardiovascular Risk in Healthy Middle-Aged Adults

https://doi.org/10.1016/j.amjcard.2016.08.045Get rights and content

Men tend to develop cardiovascular disease (CVD) earlier in life than women. Whether this difference is attributable only to gender is a matter of debate. The purpose of this study was to evaluate gender differences in cardiovascular risk in a large cohort of asymptomatic men and women and explore gender-related risk in prespecified risk factor subgroups. We investigated 14,966 asymptomatic men and women free of diabetes, hypertension, or ischemic heart disease who were annually screened. The primary end point of the present study was the occurrence of ischemic or cerebrovascular disease as composite end point. Multivariate Cox proportional hazards regression modeling was used to assess the gender difference regarding CVD and to examine the association between CVD risk factors and gender. Mean age of the study population was 47 ± 10 years and 30% were women. Kaplan–Meier survival analysis showed that at 6.2 ± 3.9 years' follow-up, the rate of CVD events was 6.1% among men compared with 1.8% among women (log-rank p <0.001). Consistently, multivariate analysis demonstrated that male gender was independently associated with a significant threefold increased risk for development of CVD events (hazard ratio 3.05, CI 2.25 to 4.14). The CVD risk associated with male gender was consistent in each risk subset analyzed, including older age, low high-density lipoprotein, impaired fasting glucose, and positive family history for ischemic heart disease (all p values for gender-by-risk factor interactions <0.05). Higher performance on treadmill test had a protective effect regarding CVD development in both men and women. In conclusions, healthy middle-aged men experienced increased risk for the development of CVD events compared with women independently of traditional CVD risk factors. However, better exercise capacity is associated with a protective effect.

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Methods

The Institute for Medical Screening at the Chaim Sheba Medical Center has annual screening program for executives, which performs about 10,000 screening examinations each year. All participants are self-referred asymptomatic men and women. Most participants have repeated annual visits for a number of years. This database is well suited for the characterization, follow-up, and clinical event identification of asymptomatic population.

A computerized database was established in the year 2000 and

Results

Among 14,966 study subjects, 4,442 (29%) were women. All participants were between 21 to 91 years old, mean age was 46.98 years (median age was 46 years; interquartile range 40 to 53). Baseline characteristics of the study populations by gender are presented in Table 1. Compared with men, women were younger, had lower baseline systolic blood pressure, had lower rates of obesity and impaired fasting glucose, and had a significantly better baseline lipid profile (all p value <0.001). Women's

Discussion

In the present study, we aimed to evaluate whether an independent gender difference exists regarding CVD risk in a large cohort of apparently healthy middle-aged adults. Our findings suggest that there is an independent gender difference in CVD risk between men and women and that traditional risk factors profiles cannot fully account for this risk difference. In our study, we included healthy subjects without co-morbidities such as hypertension or diabetes mellitus. This population was selected

Disclosures

The authors have no conflicts of interest to disclose.

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This work was supported by the Shalvi Foundation for Medical Research.

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