“Similar Strategy” Needed for Global CVD Prevention in Males and Females: PURE

According to an analysis of the PURE study, the magnitude of associations with major cardiovascular disease for most risk factors is similar in women and men, despite gender differences in risk factors.

In a comprehensive review of the global prevalence of metabolic, behavioral, and psychosocial risk factors for CVD in both women and men, the researchers also found that diet was more strongly associated with CVD in women than in men. However, high levels of non-HDL and related lipids and symptoms of depression were more strongly associated with cardiovascular disease risk in men than in women. The patterns remained consistent across countries, regardless of income level.

“Existing studies, mostly from high-income countries, have reported that high blood pressure, diabetes and smoking are more strongly associated with cardiovascular disease in women than in men,” Marjan Walli-Attaei, PhD, a research associate at the Population Health Research Institute of McMaster University and Hamilton Health Sciences, and colleagues wrote The lancet. “Such results would imply that women would benefit to a greater extent than men from controlling these risk factors in reducing cardiovascular disease risk. However, the burden of cardiovascular disease is greatest in low- and middle-income countries, for which there is sparse prospective data on the association of risk factors with cardiovascular disease, with a lack of analysis by gender.”

Marjan Walli Attaei

Walli-Attaei and colleagues analyzed and tracked data from 155,724 adults aged 35 to 70 years at baseline with no history of cardiovascular disease who participated in the PURE study, which included participants from 21 high-, middle- and low-income countries them for about 10 years (58% women; mean baseline age 50 years). The researchers recorded information on the participants’ metabolic, behavioral, and psychosocial risk factors; All participants had at least one follow-up visit. The primary outcome was a composite of major cardiovascular events, defined as cardiovascular death, MI, stroke, and heart failure. Researchers reported the prevalence of each risk factor in women and men, HRs and population fractions associated with major cardiovascular disease.

At the September 13, 2021 data cut-off, the researchers observed 4,280 major cardiovascular events in women (age-standardized incidence rate, 5 events per 1,000 person-years) and 4,911 in men (age-standardized incidence rate, 8.2 per 1,000 person-years). -Years).

Compared to men, women showed a more favorable cardiovascular risk profile, especially when they were younger. HRs for metabolic risk factors were similar in females and males, with the exception of non-HDL, for which high non-HDL was associated with a HR for major cardiovascular disease of 1.11 in females (95% CI, 1.01-1.21 ) and 1.28 in males (95% CI, 1.19–1.39; P for interaction = 0.0037), with a consistent pattern of higher risk in males than females with other lipid markers.

The researchers also observed that maintaining a diet with a PURE score of 4 or lower (score range 0-8) was more strongly associated with major cardiovascular disease in women than in men, with HRs of 1.17 (95% CI , 1.08-1.26) and 1.07 (95% CI, 0.99-1.15; P for interaction = 0.0065).

In contrast, depression symptoms were more strongly associated with CVD in men than women, with HRs for depression symptoms being higher in men than women (P for interaction = .0002). “The HRs of other behavioral and psychosocial risk factors, as well as grip strength and household air pollution, were similar in women and men,” the researchers wrote.

The overall population proportions associated with behavioral and psychosocial risk factors were greater in men than in women (15.7% vs. 8.4%), mainly due to the larger contribution of smoking to the population proportions in men (10, 7%) versus women (1.3%).

“Our results underscore the importance of a similar cardiovascular disease prevention strategy for both sexes,” the researchers write. “However, the increased risk of cardiovascular disease in men could be significantly mitigated with better reductions in tobacco use and lipid levels.”

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