Sex differences in lifetime risk and first manifestation of cardiovascular disease: prospective population based cohort study
Top Cited Papers
Open Access
- 17 November 2014
- Vol. 349 (nov17 9), g5992
- https://doi.org/10.1136/bmj.g5992
Abstract
Objective To evaluate differences in first manifestations of cardiovascular disease between men and women in a competing risks framework. Design Prospective population based cohort study. Setting People living in the community in Rotterdam, the Netherlands. Participants 8419 participants (60.9% women) aged ≥55 and free from cardiovascular disease at baseline. Main outcome measures First diagnosis of coronary heart disease (myocardial infarction, revascularisation, and coronary death), cerebrovascular disease (stroke, transient ischaemic attack, and carotid revascularisation), heart failure, or other cardiovascular death; or death from non-cardiovascular causes. Data were used to calculate lifetime risks of cardiovascular disease and its first incident manifestations adjusted for competing non-cardiovascular death. Results During follow-up of up to 20.1 years, 2888 participants developed cardiovascular disease (826 coronary heart disease, 1198 cerebrovascular disease, 762 heart failure, and 102 other cardiovascular death). At age 55, overall lifetime risks of cardiovascular disease were 67.1% (95% confidence interval 64.7% to 69.5%) for men and 66.4% (64.2% to 68.7%) for women. Lifetime risks of first incident manifestations of cardiovascular disease in men were 27.2% (24.1% to 30.3%) for coronary heart disease, 22.8% (20.4% to 25.1%) for cerebrovascular disease, 14.9% (13.3% to 16.6%) for heart failure, and 2.3% (1.6% to 2.9%) for other deaths from cardiovascular disease. For women the figures were 16.9% (13.5% to 20.4%), 29.8% (27.7% to 31.9%), 17.5% (15.9% to 19.2%), and 2.1% (1.6% to 2.7%), respectively. Differences in the number of events that developed over the lifespan in women compared with men (per 1000) were −7 for any cardiovascular disease, −102 for coronary heart disease, 70 for cerebrovascular disease, 26 for heart failure, and −1 for other cardiovascular death; all outcomes manifested at a higher age in women. Patterns were similar when analyses were restricted to hard atherosclerotic cardiovascular disease outcomes, but absolute risk differences between men and women were attenuated for both coronary heart disease and stroke. Conclusions At age 55, though men and women have similar lifetime risks of cardiovascular disease, there are considerable differences in the first manifestation. Men are more likely to develop coronary heart disease as a first event, while women are more likely to have cerebrovascular disease or heart failure as their first event, although these manifestations appear most often at older ages.This publication has 42 references indexed in Scilit:
- European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR)European Heart Journal, 2012
- Comparison of the Framingham and Reynolds Risk Scores for Global Cardiovascular Risk Prediction in the Multiethnic Women's Health InitiativeCirculation, 2012
- Trends in stroke incidence rates and stroke risk factors in Rotterdam, the Netherlands from 1990 to 2008European Journal of Epidemiology, 2012
- Methods of data collection and definitions of cardiac outcomes in the Rotterdam StudyEuropean Journal of Epidemiology, 2012
- Systolic blood pressure and incident heart failure in the elderly. The Cardiovascular Health Study and the Health, Ageing and Body Composition StudyHeart, 2011
- The Hazards of Hazard RatiosEpidemiology, 2010
- Systematic Examination of the Updated Framingham Heart Study General Cardiovascular Risk ProfileCirculation, 2009
- Risk Factor Burden in Middle Age and Lifetime Risks for Cardiovascular and Non-Cardiovascular Death (Chicago Heart Association Detection Project in Industry)The American Journal of Cardiology, 2007
- Tutorial in biostatistics: competing risks and multi‐state modelsStatistics in Medicine, 2006
- A note on competing risks in survival data analysisBritish Journal of Cancer, 2004