Sex differences in lifetime risk and first manifestation of cardiovascular disease: prospective population based cohort study - PubMed (original) (raw)

Bart S Ferket 2, Ewout W Steyerberg 3, Maryam Kavousi 4, Jaap W Deckers 5, Daan Nieboer 3, Jan Heeringa 4, Marileen L P Portegies 6, Albert Hofman 7, M Arfan Ikram 8, M G Myriam Hunink 9, Oscar H Franco 4, Bruno H Stricker 10, Jacqueline C M Witteman 4, Jolien W Roos-Hesselink 5

Affiliations

Sex differences in lifetime risk and first manifestation of cardiovascular disease: prospective population based cohort study

Maarten J G Leening et al. BMJ. 2014.

Abstract

Objective: To evaluate differences in first manifestations of cardiovascular disease between men and women in a competing risks framework.

Design: Prospective population based cohort study.

Setting: People living in the community in Rotterdam, the Netherlands.

Participants: 8419 participants (60.9% women) aged ≥ 55 and free from cardiovascular disease at baseline.

Main outcome measures: First diagnosis of coronary heart disease (myocardial infarction, revascularisation, and coronary death), cerebrovascular disease (stroke, transient ischaemic attack, and carotid revascularisation), heart failure, or other cardiovascular death; or death from non-cardiovascular causes. Data were used to calculate lifetime risks of cardiovascular disease and its first incident manifestations adjusted for competing non-cardiovascular death.

Results: During follow-up of up to 20.1 years, 2888 participants developed cardiovascular disease (826 coronary heart disease, 1198 cerebrovascular disease, 762 heart failure, and 102 other cardiovascular death). At age 55, overall lifetime risks of cardiovascular disease were 67.1% (95% confidence interval 64.7% to 69.5%) for men and 66.4% (64.2% to 68.7%) for women. Lifetime risks of first incident manifestations of cardiovascular disease in men were 27.2% (24.1% to 30.3%) for coronary heart disease, 22.8% (20.4% to 25.1%) for cerebrovascular disease, 14.9% (13.3% to 16.6%) for heart failure, and 2.3% (1.6% to 2.9%) for other deaths from cardiovascular disease. For women the figures were 16.9% (13.5% to 20.4%), 29.8% (27.7% to 31.9%), 17.5% (15.9% to 19.2%), and 2.1% (1.6% to 2.7%), respectively. Differences in the number of events that developed over the lifespan in women compared with men (per 1000) were -7 for any cardiovascular disease, -102 for coronary heart disease, 70 for cerebrovascular disease, 26 for heart failure, and -1 for other cardiovascular death; all outcomes manifested at a higher age in women. Patterns were similar when analyses were restricted to hard atherosclerotic cardiovascular disease outcomes, but absolute risk differences between men and women were attenuated for both coronary heart disease and stroke.

Conclusions: At age 55, though men and women have similar lifetime risks of cardiovascular disease, there are considerable differences in the first manifestation. Men are more likely to develop coronary heart disease as a first event, while women are more likely to have cerebrovascular disease or heart failure as their first event, although these manifestations appear most often at older ages.

© Leening et al 2014.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi\_disclosure.pdf and declare: MGMH receives grants from the Netherlands Organisation for Health Research and Development (ZonMw), grants from the Technology Foundation the Netherlands (STW), personal fees from Cambridge University Press, grants from National Institutes of Health (NIH), and non-financial support from the European Society of Radiology (ESR); OHF works in ErasmusAGE, a centre for ageing research across the life course funded by Nestlé Nutrition (Nestec), Metagenics, and AXA.

Figures

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Fig 1 Cumulative incidence of cardiovascular disease (defined as coronary heart disease, cerebrovascular disease, heart failure, and other cardiovascular death) and competing non-cardiovascular death for men and women aged 55. Coronary heart disease was defined as myocardial infarction, coronary revascularisation, or death from coronary heart disease. Cerebrovascular disease was defined as stroke, transient ischaemic attack, or carotid revascularisation. Other cardiovascular death included all cardiovascular mortality other than fatal coronary heart disease or stroke

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Fig 2 Cumulative incidence of first cardiovascular disease manifestations adjusted for competing non-cardiovascular death for men (left) and women (right) aged 55. Coronary heart disease was defined as myocardial infarction, coronary revascularisation, or death from coronary heart disease. Cerebrovascular disease was defined as stroke, transient ischaemic attack, or carotid revascularisation. Other cardiovascular death included all cardiovascular mortality other than fatal coronary heart disease or stroke

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