Cardiovascular Disease Has Less of an Impact on Women, Study Shows

To aid in the treatment of cardiovascular disease (CVD), women are more likely to use primary preventive measures to reduce their risk of adverse health consequence that include taking medications, controlling their high blood pressure (hypertension), and smoking cessation, while men are typically treated with secondary interventions (ie, surgical), such as percutaneous coronary intervention and coronary artery bypass graft.

Women are also less likely to die from CVD than men, according to recent study results published in The Lancet.

Using data collected between January 6, 2005, and May 6, 2019, on 168,490 participants who took part in phase 1 and phase 2 of the Prospective Urban Rural Epidemiological study, researchers were able to show these results applied to women from 21 countries and various economic backgrounds (low-, middle-, and high-income countries) regardless of their history, or lack thereof, of heart attack or stroke. The mean (SD) age of women in the study was 50.8 (9.9) years versus 51.7 (10.0) years among the men. The following were investigated:

• Risk factors
• Use of treatment
• Incidence of heart attacks and strokes
• Community mortality, rather than focusing on outcomes among hospitalized patients

“There have been concerns that women with CVD are managed less aggressively than men which could lead to women having poorer prognoses. Some have attributed this to a treatment bias against women,” said Marjan Walli-Attaei, PhD, the study’s first author and a research fellow at the Population Health Research Institute of McMaster University and Hamilton Health Sciences in Ontario, Canada, which conducted the study, in a statement. “But overall, outcomes such as death or a new heart attack or stroke in women were lower than in men.”

Overall, the CVD risk factor burden was shown to be lower among women, based on the scores they received using risks delineated in the INTERHEART study and via the Framingham Risk Score Calculator. This advantage carries over into the lower incidence of CVD (adjusted HR [aHR], 0.75; 95% CI, 0.72-0.79) and all-cause death (aHR, 0.62; 95% CI, 0.60-0.65) in women compared with men, per 1000 person-years:

• Incidence of CVD: 4.1 (95% CI, 4.0-4.2) versus 6.4 (95% CI, 6.2-6.6)
• All-cause death: 4.5 (95% CI, 4.4-4.7) versus 7.4 (95% CI, 7.2-7.7)

Women were also shown to have a lower risk of recurrent CVD events than men (aHR, 0.73; 95% CI, 0.64-0.83), also per 1000 person-years, as well as 30-day mortality after a CVD event:

• Recurrent CVD events: 20.0 (95% CI, 18.2-21.7) versus 27.7 (95% CI, 25.6-29.8)
• 30-day mortality: 22% versus 28% (P < .0001)

One additional unsettling finding was the large gap in survival rates among women and men in low-income compared with high-income countries, and the authors emphasized that it deserves further study. Compared with the less than 10% of patients who suffer a CVD event, such as a heart attack or stroke, and die within 30 days in high-income countries, almost 40% of these same patients will likely die in a low-income country.

“Improving cardiovascular disease prevention and treatment, especially in [low-income and middle-income countries], should be vigorously pursued in both women and men,” the authors concluded.

Reference

Walli-Attaei M, Joseph P, Rosengren A, et al. Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet. Published online May 20, 2020. doi:10.1016/S0140-6736(20)30543-2