Background: Women are underrepresented in cardiovascular trials, and data regarding gender differences with respect to cardiovascular risk stratification are therefore limited. The purpose of the current study was to evaluate gender differences in cardiovascular risk in a large cohort of asymptomatic men and women.
Methods: We investigated 14,966 men and women free of diabetes, hypertension or IHD who were annually screened in a tertiary medical center in Israel. All subjects were asymptomatic, filled a health questionnaire and underwent physical examination, routine blood tests including fasting plasma glucose and lipid profile and treadmill exercise stress testing. The primary end point of the current study was the composite of ischemic and cerebrovascular disease.
Results: Mean age of study population was 46.27±9.95 and 30% were women. During a mean follow up of 2,346 ± 1,432 days there were 719 incident cardiovascular events. Compared with men, women were younger, had lower rates of dyslipidemia, impaired fasting glucose and obesity. Multivariate Cox regression analysis adjusted for traditional cardiovascular risk factors showed that men were 3.4-fold more likely to develop CVD compared with women (95% CI 2.52-4.55, p<0.001). However, subgroup analysis showed that the gender-related risk was age-dependent, where in older age-group (≥45 years) men showed a significantly higher event rate compared with women (Figure left panel) whereas among younger subjects the rate of CVD events was similar between men and women (Figure right panel). Multivariate analysis showed that the risk increase among male ≥45 years was independent of traditional CVD risk factors including factors such as obesity, low HDL, high LDL, high systolic blood pressure, impaired fasting glucose levels, exercise duration and capacity.
Conclusions: Our findings suggest that in healthy middle-aged adults men experience a significant increase in the risk for the development of CVD events compared with women regardless of traditional CVD risk factors.
