For women and men, the risk factors for cardiovascular disease are largely the same, according to a large global study involving the University of Gothenburg.
The study, now published in The Lancet, includes participants from both high-income and middle- and low-income countries. Cardiovascular diseases are more prevalent in the latter. Data are from the Prospective Urban and Rural Epidemiological Study (PURE).
The study included 155,724 people in 21 countries, on five continents. Aged between 35 and 70, the participants had no history of cardiovascular disease when they joined the study. All fatal cases of cardiovascular disease, heart attacks, strokes and heart failure during the follow-up period, which averaged ten years, were recorded.
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 difference between gender or income
Metabolic risk factors were found to be similar in both sexes, with the exception of elevated low-density lipoprotein (LDL, often called bad cholesterol) values, where the association with cardiovascular disease was stronger in men. In the opinion of the researchers, however, this finding needs to be confirmed by further studies.
Depressive symptoms were another risk factor for cardiovascular disease that was found to be more important in men than in women. In contrast, the link between poor diet and cardiovascular disease was stronger in women; and smoking, although significantly more common in men, was an equally harmful 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 also highlights the importance of disease prevention strategies, which are the same for both genders.
Similarities greater than differences
The lower overall risk of cardiovascular disease in women, particularly heart attack (myocardial infarction), may be explained by younger women’s higher tolerance to risk factors. Their estrogens make vessel walls more flexible and affect the liver’s ability to get rid of LDL.
Among the women in the study (90,934 people), 5.0 cases of stroke, heart attack and/or cardiovascular disease were recorded per 1,000 people per year. The corresponding number in the male group (64,790 individuals) was 8.2 cases.
Annika Rosengren, Professor of Medicine at Sahlgrenska Academy, University of Gothenburg, is the study’s second author, in charge of the Swedish part of the PURE population study of 4,000 individuals in Gothenburg and Skaraborg.
When it comes to cardiovascular disease in men and women, the similarities in terms of risk factors are considerably more important 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 the coronary arteries at a younger age than women, and tend to develop a myocardial infarction much earlier. When it comes to early stroke, however, the gender differences are less pronounced, as we have also found in other studies.
Annika Rosengren, Professor of Medicine at Sahlgrenska Academy, University of Gothenburg
Walli-Attaei, M., et al. (2022) Metabolic, behavioral and psychosocial risk factors and cardiovascular disease in women compared to 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.