Image illustrating man with cardiovascular disease
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Women and men share most of the same risk factors for cardiovascular disease (CVD), a large international study has found. This was the first such study to include people from low- and middle-income countries where the burden of CVD is the greatest. Women had a lower risk of CVD than men. Also, diet was more strongly associated with CVD risk in woman than men.

“Women and men have similar CVD risk factors, which emphasizes the importance of a similar strategy for the prevention of CVD in men and women,” said the paper’s first author, Marjan Walli-Attaei, a research fellow at the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences (HHS).

The study was published this week in The Lancet.

According to the U.S. CDC, heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the US. About 697,000 people in the United States died from heart disease in 2020, comprising one in every five deaths in this country.

The global Prospective Urban Rural Epidemiological (PURE) study assessed risk factors, including metabolic (such as high blood pressure, obesity and diabetes), behavioral (smoking and diet), and psychosocial (economic status and depression) in about 156,000 people without a history of CVD between the ages of 35 and 70.

From 21 low, middle, and high-income countries on five continents, the subjects were followed for an average of 10 years. The primary outcome was a composite of major cardiovascular—cardiovascular disease deaths, myocardial infarction, stroke, and heart failure.

As of data cutoff (Sept 13, 2021), 4280 major cardiovascular disease events had occurred in women (age-standardized incidence rate of 5·0) and 4911 in men (8·2 per 1000 person-years).

Overall, women had a lower risk of developing CVD than men, especially at younger ages.

High levels of bad (LDL) cholesterol and symptoms of depression were more strongly associated with CVD risk in men than in women. Meanwhile, diet was more strongly associated with the risk of cardiovascular disease in women than in men.

The patterns of the team’s findings were generally similar in countries with all levels of income.

The fact that diet was more strongly associated with CVD risk in woman than men is, “Something that’s not been previous described, and which requires independent confirmation,” said Salim Yusuf, lead investigator of the study, senior author of the paper, executive director of PHRI, professor of medicine at McMaster University, and cardiologist at HHS.

More widespread screening for familial hypercholesterolemia (FH) has been suggested as a means to identify people at higher risk of heart disease.

FH is a relatively common genetic condition impacting 1 in 250 people in the U.S. that results in abnormally high levels of low-density lipoprotein (LDL) cholesterol, which can cause atherosclerosis and other forms of heart disease in those affected.

While testing for cholesterol levels and other cardiovascular risk factors is recommended every 4-6 years in the U.S., FH screening is not standard and genetic testing for this condition is not always covered by health insurance policies.

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