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Sex Differences in Age of Onset of Premature Cardiovascular Disease and Subtypes: The Coronary Artery Risk
Alexa A Freedman1, Laura A Colangelo1, Hongyan Ning1
1Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL USA.
Insights
Men develop cardiovascular disease (CVD) earlier than women, particularly coronary heart disease (CHD). This sex gap in CVD risk emerges at age 35 and persists through midlife.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Historical data show men develop coronary heart disease (CHD) 10 years earlier than women.
- Contemporary persistence of this sex gap in cardiovascular disease (CVD) risk is unknown, especially with changing cardiometabolic profiles.
- Differences in stroke and heart failure incidence by sex are also not well-established.
Purpose of the Study:
- To determine if the sex gap in premature cardiovascular disease (CVD) onset persists in a contemporary US adult cohort.
- To compare sex differences in the incidence of specific CVD subtypes: coronary heart disease (CHD), heart failure, and stroke.
- To identify the age at which sex differences in CVD risk begin to emerge.
Main Methods:
- Analysis of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective multicenter cohort.
- Follow-up of US adults (aged 18-30 at enrollment 1985-1986) through August 2020.
- Comparison of cumulative incidence functions for premature CVD and subtypes using Gray's test.
Main Results:
- Men showed a significantly higher cumulative incidence of CVD, CHD, and heart failure compared to women (P<0.05).
- No significant sex difference was observed for stroke incidence (P=0.63).
- Men reached 5% CVD incidence 7 years earlier than women (age 50.5 vs. 57.5). CHD incidence diverged significantly, with men reaching 2% incidence 10.1 years earlier.
Conclusions:
- Men develop cardiovascular disease (CVD) earlier than women, with the most pronounced difference seen in coronary heart disease (CHD).
- Sex differences in CVD risk become apparent at age 35 and continue through midlife.
- These disparities are not mitigated by accounting for overall cardiovascular health.
Background:
Historical data indicate men develop coronary heart disease (CHD) 10 years before women. However, whether this sex gap persists in a contemporary sample amid changing cardiometabolic risk profiles, and whether differences exist for other cardiovascular disease (CVD) subtypes (ie, stroke, heart failure), is not known.
Methods:
Data are from the CARDIA (Coronary Artery Risk Development in Young Adults) study, a prospective multicenter cohort study. US adults aged 18 to 30 years enrolled in 1985 to 1986 and were followed through August 2020. Sex differences in the cumulative incidence functions of premature CVD (onset <65 years), overall and for each subtype (CHD, heart failure, stroke), were compared using Gray's test.
Results:
Among 5112 participants (54.5% female, 51.6% Black) with a mean age of 24.8 years (SD: 3.7) at enrollment and a median follow-up of 34.1 years (interquartile range, 33.8-35.7), men had a significantly higher cumulative incidence of CVD, CHD, and heart failure (P<0.05 for all), with no difference in stroke (P=0.63). Men reached 5% incidence of CVD 7.0 years earlier than women (50.5 versus 57.5 years, P<0.001). CHD was the most frequent CVD subtype, and men reached 2% incidence 10.1 years earlier than women (P<0.001). Men and women reached 2% stroke and 1% heart failure incidence at similar ages. Ten-year CVD event rates diverged at an index age of 35.
Conclusions:
Men developed CVD earlier than women, with the greatest difference observed for CHD. Sex differences in CVD risk emerged at age 35, persisted through midlife, and were not attenuated by accounting for cardiovascular health.
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