Rationale and tutorial for analysing and reporting sex differences in cardiovascular associations

Area of Science:

• Cardiology
• Epidemiology
• Sex Differences in Health

Background:

• Cardiovascular disease (CVD) is a leading cause of mortality for both sexes.
• Historical research bias towards a male model of CVD may lead to underestimation of its impact in women.
• Biological and social factors differ between sexes, influencing CVD risk and presentation.

Purpose of the Study:

• To advocate for sex-disaggregated data as standard practice in cardiovascular disease research.
• To provide guidance on designing and analyzing studies that compare cardiovascular disease risk factors between sexes.
• To highlight the importance of quantifying sex differences in CVD associations.

Main Methods:

• The article provides a tutorial for analyzing sex comparisons using individual participant data and meta-analyses of sex-specific summary data.
• Methods include strategies for reducing bias and increasing efficiency in sex-comparative research.
• Worked examples illustrate the application of these analytical approaches.

Main Results:

• Sex differences in risk factor associations with CVD exist but are often unrecognized.
• Estimating the magnitude of sex differences (e.g., ratios of relative risks) is crucial, rather than solely relying on statistical significance testing.
• When no significant sex difference is found, conclusions should not be sex-specific.

Conclusions:

• Sex-disaggregated analysis is essential for both humanitarian and clinical reasons in CVD research.
• Standardized methods for sex comparisons will improve the understanding and management of cardiovascular disease.
• Accurate estimation and reporting of sex differences are paramount for advancing cardiovascular health equity.