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Risk factors and the sex differential in coronary artery disease
1Wolfson Unit for Prevention of Peripheral Vascular Diseases, Department of Public Health Sciences, University of Edinburgh, United Kingdom.
Insights
Men have a higher incidence of coronary artery disease due to various risk factors. Biological susceptibility and protective factors like high-density-lipoprotein cholesterol may explain these sex differences.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Endocrinology
Background:
- Coronary artery disease (CAD) incidence is significantly higher in men than women in industrialized nations.
- Existing research suggests risk factor prevalence alone does not fully explain this sex differential.
Purpose of the Study:
- To review and analyze the contribution of various coronary risk factors to the observed sex differential in CAD incidence.
- To explore potential biological susceptibilities and protective factors influencing CAD risk between sexes.
Main Methods:
- Systematic review of epidemiological studies on coronary risk factors in men and women.
- Comparative analysis of prevalence and susceptibility to factors like smoking, hypertension, hypercholesterolemia, and lipid profiles.
- Examination of the role of body fat distribution and metabolic factors (insulin resistance) in sex-based CAD risk.
Main Results:
- Higher levels of cigarette smoking, hypertension, and hypercholesterolemia are observed in middle-aged men.
- Increased biological susceptibility to these risk factors in men may contribute to higher CAD rates.
- Higher levels of protective high-density-lipoprotein cholesterol in women and specific abdominal fat distribution patterns in men are associated with lower CAD risk.
- The sex differential in CAD is reduced in diabetic populations, though research on related metabolic factors is limited.
Conclusions:
- Differences in risk factor prevalence and biological susceptibility contribute to the higher CAD incidence in men.
- Protective factors in women and specific fat distribution patterns in men play a role in mitigating CAD risk.
- Further research is needed on hemostatic factors and metabolic aspects like insulin resistance in women regarding CAD.
Abstract:
In industrialized countries, the incidence of coronary artery disease is three to four times higher in men than in women. Our review examines whether differences in the prevalence of, or susceptibility to, various coronary risk factors might contribute to this sex differential. Cigarette smoking, hypertension, and hypercholesterolemia are risk factors for coronary artery disease in both sexes and are present at higher levels in middle-aged men than women. To date, such differences have failed to explain the coronary sex differential, although higher biological susceptibilities to smoking, blood pressure, and total cholesterol in men may also be important. Mean levels of protective high-density-lipoprotein cholesterol are higher in women than in men throughout life and may also contribute to the sex differential. In addition, men with a female pattern of abdominal fat distribution are at lower risk of coronary artery disease than those with a male pattern. In diabetic populations, the sex differential is greatly reduced, but studies on the effects of hyperinsulinemia and a lower insulin resistance in women compared with men are scarce. Prospective studies on the effect of fibrinogen and other hemostatic factors in women are also required.