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Gender differences on the risk evaluation of acute coronary syndromes: the CARDIO2000 study
Christina Chrysohoou1, Demosthenes B Panagiotakos, Christos Pitsavos
1Section of Preventive Cardiology, Cardiology Department, School of Medicine, University of Athens, Greece.
Insights
Coronary heart disease (CHD) risk factors impact men and women differently. While family history and high cholesterol pose greater risks for men, hypertension significantly affects women more. Protective factors like education and diet benefit women more.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Coronary heart disease (CHD) is more prevalent in men than women.
- Potential gender-specific impacts of cardiovascular risk factors on CHD development are not fully understood.
- Understanding these differences is crucial for targeted prevention strategies.
Purpose of the Study:
- To analyze the extent to which cardiovascular risk factors explain gender differences in CHD risk at a population level.
- To investigate how specific risk factors differentially affect men and women regarding acute coronary syndrome (ACS).
Main Methods:
- A case-control study involving 848 patients with first ACS and 1078 controls, selected from all Greek regions (2000-2001).
- Patients and controls were paired by gender, age, and region.
- Multivariate analysis was used to assess the association between risk factors and CHD, adjusting for age.
Main Results:
- Women experiencing ACS were significantly older than men (65.3 vs. 59.7 years).
- ACS occurred more frequently in men (4:1 ratio).
- Family history and hypercholesterolemia increased risk more in men, while hypertension had a greater effect in women. Higher education and Mediterranean diet showed more protection for women. Depression was more strongly associated with risk in women.
Conclusions:
- The contribution of specific coronary risk factors to CHD risk differs significantly between men and women.
- Hypertension, education, Mediterranean diet, and depression exhibit gender-specific associations with CHD risk.
- These findings highlight the need for gender-tailored approaches in CHD prevention and management.
Abstract:
Coronary heart disease (CHD) is more common in men than women. Gender differences in CHD risk may be explained by a different impact that coronary risk factors may have for men and women, in the development of CHD. Thus, the authors aimed to analyze the extent to which cardiovascular risk factors can explain the gender difference in CHD risk, at population level. During 2000-2001, 848 hospitalized patients with a first event of acute coronary syndrome and 1078 controls, paired by gender, age, and region with no evidence of overt CHD, were randomly selected from all Greek regions. Data revealed that women experiencing their first acute coronary syndrome were significantly older than men (65.3+/-8 vs. 59.7+/-10 years old; p<0.01), and that acute coronary syndrome occurred more frequently in men than women (frequency ratio 4:1, men:women). When adjusting for age, multivariate analysis revealed that both family history of premature CHD and hypercholesterolemia were associated with higher coronary risk in men than women (odds ratio [OR]=5.11 vs. 3.14; p<0.05 for family history and OR=3.77 vs. 2.19; p<0.05 for hypercholesterolemia). The presence of hypertension however, had a significantly greater effect in women than men (OR=4.86 vs. 1.66; p<0.01). Also, higher education level and the adoption of a Mediterranean diet had a more protective effect in women than men (OR=0.53 vs. 0.87; p<0.001; and OR=0.80 vs. 0.96; p<0.05, respectively). There was also evidence of a greater association between depression and higher coronary risk in women than men (OR=1.93 vs. 1.58; p<0.07). The impact of other factors (i.e., smoking, diabetes, body mass index, physical activity, alcohol consumption, and financial status), on the coronary risk difference between genders was similar for men and women. In conclusion, our findings suggest that the contribution of certain coronary risk factors to the risk for CHD is different for men and women.