Gender differences in risk factors and their control

1

• Gender differences in risk factors and their
  control
• Smoking, Hypertension and Hypercholesterolaemia
• Guy De Backer
• Department of Public Health Ghent University,
  Ghent, Belgium Brussels nov.10th 2007

2
Sex differentials in CHD

• CHD rates
• Differences in prevalence rates
• Differences in Relative Risks(RR)
• Attributable fractions
• Differences in prevalence rates and in RRs

3
Gender differences in smoking, hypertension,
hypercholesterolaemia

• Differences in prevalence rates by gender
• Gender differences in the RRs for CHD related to
  these risk factors
• Differences in the efficacy of intervention for
  their control
• Associations between their control and risk
  reduction in both gender

4
Prevalence of smoking, adults 15 yr , by gender,
latest available year
40 30 20 10
10 20 30 40 50 60

Ireland Germany Netherlands Spain
Denmark UK Belgium France Finland Sweden Albania
Italy Russian Fed.
Men
Women
WHO, 2004, http//www.who.dk
5
Smoking and risk of myocardial infarction in
women and men longitudinal population
studyPrescott et al. BMJ 19983161043
6
Smoking, quitting and the risk of CVD among women
and men in the Asia-Pacific region
Hazard ratio, adjusted for age and SBP for CHD by
number of cigarettes per day smoked for women and
men Int J Epid 2005, May 24
7
Arterial blood pressure by age and sexBIRNH
mmHg
mmHg
160
160
140
140
120
120
Men
Women
100
100
80
80
60
60
25- 35- 40- 55-
65-74 Age / yr
mean of two measurements
8
International Journal of Epidemiology (2004)

www.heartstats.org
9
SBP/DBP mmHg
140-159 80-89
140-159 90-99
140-159 100
160 80-89
160 90-99
160 100
120-139 80-89
140-159 lt80
lt120 lt80
120-139 lt80
10
120-139 80-89
140-159 80-89
140-159 90-99
140-159 100
160 80-89
160 90-99
160 100
lt120 lt80
120-139 lt80
140-159 lt80
SBP/DBP mmHg
11
Knowledge, treatment and control of hypertension
in BIRNH (1980-83) and MONICA-BELGIUM (1985-92),
by gender
12
Effect of antihypertensive drug treatment on
Cardiovascular outcomes in Women and Men

• A meta-analysis of individual patient data from
  randomized,controlled trials
• Gueyffier F et al. Ann Int Med 1997126761

In terms of relative risk, treatment benefit did
not differ between women and men. The absolute
risk reduction attributable to treatment seemed
to depend on untreated risk. The findings
underline the need to predict accurately the
untreated cardiovascular risk of an individual
person in order to rationalize and individualize
antihypertensive treatment
13
CHOLESTEROL

• Risk of CHD is directly related to blood
  cholesterol levels in both gender
• 60 of CHD in developed countries is due to
  total cholesterol levels in excess of the optimal
  concentration (WHO report 2002)
• INTERHEART estimated that 45 of heart attacks in
  Western Europe and 35 in Central and Eastern
  Europe are due to abnormal blood lipids

14
International Journal of Epidemiolgy (2004)

www.heartstats.org
15
Do lipids, blood pressure, diabetes and smoking
confer equal risks of myocardial infarction in
women as in men?The Reykjavik StudyJonsdottir
LS et al. J Cardiovasc Risk 2002967
Independent of age, SBP, LVH, diabetes,
glycaemia, BMI, smoking, previous CHD
16
Prevalence, awareness and treatment of
hypercholesterolaemia in 32 populations results
from the WHO MONICA projectTolonen N et al. Int
J Epid 200534181
17
EUROASPIRE III

• To determine in patients with established CHD
  whether the European guidelines on cardiovascular
  disease prevention have been implemented.
• 22 countries 75 centres
• 8966 Patients lt 80 yrs old
• 6698 Men - 2268 Women
• Standardised methods
• Trained technicians
• 2006-2007

18
EUROASPIRE IIITreatment and control of elevated
cholesterol by gender
19
(No Transcript)
20
Conclusions ( 1 )

• Prevalence
• -Smoking worse in men except in the young
• -BP and Chol. better in young women
  worse in older women
• Relative Risk of CHD
• -Smoking worse in women
• -BP and Chol. slightly higher in women
• Absolute Risk of CHD Lower in women

21
Sex differentials in CHD in low risk people

• Incidence of CHD Men Women
• Non smokers 15/10.000
  4/10.000
• SBP lt 105 mmHg
• T.chol lt 185 mg/dl 4/1
• The Framingham study. Am Heart J 1986111383

22
Conclusions ( 2 )

• Detection, treatment and control
• Hypertension better in women
• Hypercholesterolaemia
• in secondary prevention worse in women
• Potential for CHD prevention
• Similar in both gender