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Sex differences in associations of comorbidities with incident cardiovascular disease: focus on absolute risk

Just Dronkers1, Laura M G Meems1, Dirk J van Veldhuisen1

  • 1Department of Cardiology, University of Groningen, University Medical Center Groningen, AB43, Hanzeplein 1, Groningen 9713 GZ, the Netherlands.

European Heart Journal Open
|August 3, 2022
PubMed

Insights

Cardiovascular disease (CVD) risk differs by sex. While hypertension poses a greater absolute CVD risk increase in men, women face higher relative risks for hypertension, type-2 diabetes, and atrial fibrillation (AF).

Area of Science:

  • Cardiovascular epidemiology
  • Sex differences in disease risk
  • Public health

Background:

  • Obesity, type-2 diabetes, hypertension, and atrial fibrillation (AF) are significant risk factors for cardiovascular disease (CVD).
  • Understanding sex-specific differences in these associations is crucial for targeted prevention strategies.
  • Previous research has yielded mixed results regarding sex-based disparities in CVD risk associated with common comorbidities.

Purpose of the Study:

  • To investigate sex-based differences in the associations between obesity, type-2 diabetes, hypertension, and AF with incident CVD.
  • To focus on both absolute and relative risk measures to provide a comprehensive understanding of these sex differences.
  • To analyze data from the PREVEND cohort to assess these associations over a median follow-up of 12.5 years.

Main Methods:

  • Utilized Poisson regression to calculate incidence rate differences (IRD) and incidence rate ratios (IRR) for CVD.
  • Calculated sex differences using women-to-men differences (WMD) for absolute risk and women-to-men ratios (WMR) for relative risk.
  • Included 7994 individuals without prior CVD, with a mean age of 49.1 years and 51.2% women.

Main Results:

  • Absolute CVD risk was lower in women (6.73 per 1000 person-years) compared to men (14.58 per 1000 person-years).
  • The increase in absolute CVD risk associated with hypertension was lower in women than in men (WMD: -6.12).
  • Relative risk measures indicated higher CVD risk in women for hypertension (WMR: 1.49%), type-2 diabetes (WMR: 1.73), and AF (WMR: 2.53).

Conclusions:

  • While the absolute increase in CVD risk from hypertension is greater in men, no significant sex differences were found for obesity, type-2 diabetes, or AF in absolute terms.
  • On a relative scale, hypertension, type-2 diabetes, and AF are associated with a higher CVD risk in women compared to men.
  • These findings highlight the importance of considering sex-specific risk profiles in cardiovascular disease prevention and management.
Abstract

Keywords:
Absolute riskComorbiditiesIncident cardiovascular diseaseRelative riskSex-related differences

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