Abstract 12068: Sex Differences in Lifetime Risk and First Manifestation of Cardiovascular Disease: An Evidence Gap in Preventive Cardiology
Introduction: Knowledge on the first manifestation of cardiovascular disease (CVD) is relevant for primary prevention and data on sex differences of first manifestations of CVD are scarce.
Hypothesis: We sought to evaluate differences in first CVD manifestations between men and women in a competing risks framework.
Methods: We used data from 8419 participants (60.9% women), aged 55 years and older, of the prospective population-based Rotterdam Study cohorts to estimate lifetime risks of CVD and its first-incident fatal or nonfatal manifestations (coronary heart disease [CHD], cerebrovascular disease, heart failure, and other CVD death) at various ages. Competing risks among the different first CVD manifestations and non-cardiovascular death were taken into account in all analyses. Regression models were adjusted for cardiovascular risk factors.
Results: During a follow-up of up to 20.1 years, 2888 participants developed CVD. Lifetime risk of CVD at age 55 was similar for both sexes with 67.1% (95% CI 64.7-69.5) for men and 66.4% (95% CI 64.2-68.7) for women (P=0.34 for difference between sexes). Lifetime risks of first CVD manifestations coronary heart disease, cerebrovascular disease, heart failure, and other CVD death were 27.2% (95% CI 24.1-30.3), 22.8% (95% CI 20.4-25.1), 14.9% (95% CI 13.3-16.6), and 2.3% (95% CI 1.6-2.9) for men, and 16.9% (95% CI 13.5-20.4)(P<0.001 for difference between sexes), 29.8% (95% CI 27.7-31.9)(P<0.001), 17.5% (95% CI 15.9-19.2)(P=0.014), and 2.1% (95% CI 1.6-2.7)(P=0.39) for women. Compared to CHD, competing cause-specific hazards for were higher for cerebrovascular disease (P<0.001) and heart failure (P=0.010) as the first CVD manifestations in women than in men. A similar pattern was observed when analyses were restricted to hard atherosclerotic CVD outcomes.
Conclusions: At age 55, men and women have similar lifetime risks of CVD. However, sex differences in the first manifestation of CVD are large with coronary heart disease being the most common initial manifestation of CVD in men, whereas in women CVD unveils itself most frequently with cerebrovascular disease followed by heart failure. Our results underscore the importance of adequate risk factor control for stroke and heart failure in women.
Author Disclosures: M.J. Leening: None. B.S. Ferket: None. M. Kavousi: None. E.W. Steyerberg: None. J.W. Deckers: None. D. Nieboer: None. J. Heeringa: None. M.L. Portegies: None. A. Hofman: None. A. Ikram: None. M.G. Hunink: Research Grant; Significant; MGMH reports receiving grants from the Netherlands Organisation for Health Research and Development (ZonMw); STW Technology Foundation; and NIH. Honoraria; Modest; MGMH reports receiving royalties for a textbook: Decision Making in Health and Medicine. Other; Modest; MGMH reports receiving travel reimbursement from the European Society of Radiology. O.H. Franco: Research Grant; Significant; OHF reports receiving grants from Nestlé Nutrition (Nestec Ltd.), Metagenics Inc., and the AXA Research Fund to establish a centre on ageing research (ErasmusAGE). B.H. Stricker: None. J.C. Witteman: None. J.W. Roos-Hesselink: None.
- © 2014 by American Heart Association, Inc.