A ‘similar strategy’ is required for global CVD prevention in men and women: PURE

September 23, 2022

2 minutes to read

Disclosures:
One author reported receiving speaker and consultant fees from Bayer and Janssen for work unrelated to this study. Wali Atai and the other authors did not report any relevant financial disclosures.


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The magnitude of associations with major CVDs for most risk factors is similar in women and men, despite gender differences in levels of risk factors, according to PURE دراسة Study Analysis.

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

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“Current studies, mostly from high-income countries, have reported that hypertension, diabetes and smoking are more closely associated with cardiovascular disease in women than in men,” Marjan Wali Attay, Ph.D., Research Fellow at McMaster University’s Population Health Research Institute and Health Sciences in Hamilton, and colleagues write in scalpel; Such findings suggest that women would benefit to a greater extent in reducing cardiovascular disease risk from controlling these risk factors than men. However, the burden of cardiovascular disease is greater in low- and middle-income countries, where projected data on the association of cardiovascular disease risk factors are sparse, with analysis by sex scarce.”

Morgan Wali Attay

Walli-Attaei and colleagues analyzed data from 155,724 adults aged 35 to 70 years at baseline with no history of cardiovascular disease enrolled in the PURE Study, which included participants from 21 high, middle, and low-income countries, and followed them for approximately 10 years (58 % women; mean baseline age, 50 years). The researchers recorded information on metabolism, behavior, and Psychosocial risk factors; All participants had at least one follow-up visit. The primary outcome was a combination of major CV events, defined as CV death, myocardial infarction, stroke, and HF. The researchers reported the prevalence of each risk factor in women and men, and the HR and population-attributable fractures associated with major CVDs.

As of the data cut-off on September 13, 2021, researchers observed 4,280 major CVD 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) .

Compared to men, women presented a more favorable CV risk profile, especially at younger ages. The HR for metabolic risk factors was similar in women and men, with the exception of non-HDL, where a higher non-HDL HR was associated with a major cardiovascular disease HR of 1.11 in women (95% CI, 1.01–1.21) and 1.28 in men (95% CI). , 1.19-1.39; s for interaction = .0037), with a consistent pattern of higher risk among men than in women with other lipid profiles.

The researchers also noted that maintaining a diet with a PURE score of 4 or less (outcome range, 0-8) was associated with a greater strength of major cardiovascular disease in women than in men, with a heart rate of 1.17 (95% CI, 1.08-1.26) and 1.07 (95% CI, 0.99-1.15; s for reaction = .0065), respectively.

In contrast, depressive symptoms were more related to CVD in men than in women, with a higher heart rate for depressive symptoms in men than in women (s for reaction = .0002). “HR for behavioral, psychosocial, and social risk factors, as well as grip strength and household air pollution, were similar between women and men,” the researchers wrote.

Total population-attributable fractures associated with behavioral and psychosocial risk factors were greater in men than in women (15.7% vs. 8.4%) mostly due to the greater contribution of smoking to population-attributed fractures in men (10.7%) vs. women. (1.3%).

“Our results underscore the importance of a similar strategy for preventing cardiovascular disease in both sexes,” the researchers wrote. “However, the increased risk of cardiovascular disease in men may be mitigated significantly by better reducing tobacco use and lipid concentrations.”