Sex-based differences in risk factors for incident myocardial infarction and stroke in the UK Biobank

Autor: Elizabeth Remfry, Maddalena Ardissino, Celeste McCracken, Liliana Szabo, Stefan Neubauer, Nicholas C Harvey, Mamas A Mamas, John Robson, Steffen E Petersen, Zahra Raisi-Estabragh
Rok vydání: 2023
Předmět:
Zdroj: European Heart Journal - Quality of Care and Clinical Outcomes.
ISSN: 2058-1742
2058-5225
DOI: 10.1093/ehjqcco/qcad029
Popis: Aim This study examined sex-based differences in associations of vascular risk factors with incident cardiovascular events in the UK Biobank. Methods Baseline participant demographic, clinical, laboratory, anthropometric, and imaging characteristics were collected. Multivariable Cox regression was used to estimate independent associations of vascular risk factors with incident myocardial infarction (MI) and ischaemic stroke for men and women. Women-to-men ratios of hazard ratios (RHRs), and related 95% confidence intervals, represent the relative effect-size magnitude by sex. Results Among the 363 313 participants (53.5% women), 8 470 experienced MI (29.9% women) and 7 705 experienced stroke (40.1% women) over 12.66 [11.93, 13.38] years of prospective follow-up. Men had greater risk factor burden and higher arterial stiffness index at baseline. Women had greater age-related decline in aortic distensibility. Older age [RHR: 1.02 (1.01–1.03)], greater deprivation [RHR: 1.02 (1.00–1.03)], hypertension [RHR: 1.14 (1.02–1.27)], and current smoking [RHR: 1.45 (1.27–1.66)] were associated with a greater excess risk of MI in women than men. Low-density lipoprotein cholesterol was associated with excess MI risk in men [RHR: 0.90 (0.84–0.95)] and apolipoprotein A (ApoA) was less protective for MI in women [RHR: 1.65 (1.01–2.71)]. Older age was associated with excess risk of stroke [RHR: 1.01 (1.00–1.02)] and ApoA was less protective for stroke in women [RHR: 2.55 (1.58–4.14)]. Conclusion Older age, hypertension and smoking appeared stronger drivers of cardiovascular disease in women, whereas lipid metrics appeared stronger risk determinants for men. These findings highlight the importance of sex-specific preventive strategies and suggest priority targets for intervention in men and women.
Databáze: OpenAIRE
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