A large global study involving the University of Gothenburg shows that the risk factors for cardiovascular disease are largely the same for women and men.
The study, just published in The Lancet, includes participants from high-income and middle- and low-income countries. Cardiovascular diseases are more prevalent in the latter. The data comes from the Prospective Urban Rural Epidemiological (PURE) study.
The study included 155,724 individuals in 21 countries, on five continents. Aged between 35 and 70, the participants had no history of cardiovascular disease when they joined the study. All cases of fatal cardiovascular disease, infarction, stroke and heart failure were recorded during the follow-up period, which averaged ten years.
The risk factors studied were metabolic (such as high blood pressure, obesity and diabetes), behavioral (smoking and diet) and psychosocial (economic status and depression).
No clear division between gender or income
Metabolic risk factors were found to be similar in both sexes, with the exception of elevated low-density lipoprotein (LDL, often called bad cholesterol) values, for which the association with cardiovascular disease was stronger in men. . In the opinion of the researchers, however, this finding needs to be confirmed by other studies.
Depressive symptoms were another risk factor for cardiovascular disease that was found to be more significant in men than in women. In contrast, the link between poor diet and cardiovascular disease was stronger in women; and smoking, although significantly more common in men, was an equally detrimental risk factor for women.
Overall, the researchers found that risk factors for cardiovascular disease were broadly similar among male and female participants, regardless of their country’s income level. This highlights the importance of disease prevention strategies, which should also be the same for both genders.
Similarities greater than the differences
The lower overall risk of cardiovascular disease, particularly heart attack (myocardial infarction), may be explained by young women’s greater tolerance to risk factors. Their estrogens make vessel walls more flexible and affect the liver’s ability to get rid of LDL.
Among the women participating in the study (90,934 people), 5.0 cases of stroke, heart attack and/or cardiovascular disease were recorded per 1,000 people per year. The corresponding number in the male group (64,790 individuals) was 8.2 cases.
Annika Rosengren, a professor of medicine at the Sahlgrenska Academy of the University of Gothenburg, is the second author of the study, responsible for the Swedish part of the PURE population study involving 4,000 people in Gothenburg and Skaraborg.
When it comes to cardiovascular disease in men and women, the similarities in terms of risk factors are considerably more important than the differences. But men are more vulnerable to high levels of LDL, the bad cholesterol, and we know from other studies that they develop pathological changes in the coronary arteries at an earlier age than women, and that ‘they tend to develop myocardial infarction much earlier. When it comes to early strokes, however, the gender differences are less pronounced, as we have also found in other studies. »
Annika Rosengren, Professor of Medicine at Sahlgrenska Academy, University of Gothenburg.
Walli-Attaei, M., et al. (2022) Metabolic, behavioral and psychosocial risk factors and cardiovascular disease in women compared to men in 21 high, middle and low income countries: an analysis of the PURE study. The Lancet. doi.org/10.1016/S0140-6736(22)01441-6.