Sex differences in associations of comorbidities with incident cardiovascular disease: focus on absolute risk

Author:

Dronkers Just1,Meems Laura M G1ORCID,van Veldhuisen Dirk J1ORCID,Meyer Sven12ORCID,Kieneker Lyanne M3ORCID,Gansevoort Ron T3ORCID,Bakker Stephan J L3ORCID,Rienstra Michiel1ORCID,de Boer Rudolf A1ORCID,Suthahar Navin1ORCID

Affiliation:

1. University of Groningen, University Medical Center Groningen Department of Cardiology, , AB43, Hanzeplein 1, Groningen 9713 GZ, the Netherlands

2. Heart Center Oldenburg, Department of Cardiology, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg , Oldenburg, Germany

3. University of Groningen, University Medical Center Groningen Department of Internal Medicine, Division of Nephrology, , Groningen, the Netherlands

Abstract

Abstract Aim To examine sex differences in associations of obesity, type-2 diabetes, hypertension, and atrial fibrillation (AF) with incident cardiovascular disease (CVD), focusing on absolute risk measures. Methods and results We included a total of 7994 individuals (mean age 49.1 years; 51.2% women) without prior CVD from the PREVEND (Prevention of Renal and Vascular End-stage Disease) cohort with a median follow-up of 12.5 years. Using Poisson regression, we calculated the increase in absolute as well as relative CVD risk associated with a comorbidity using incidence rate differences (IRD = IRcomorbidity−IRno-comorbidity) and incidence rate ratios (IRR = IRcomorbidity/IRno-comorbidity), respectively. Sex differences were presented as women-to-men differences (WMD = IRDwomen−IRDmen) and women-to-men ratios (WMR = IRRwomen/IRRmen). Absolute CVD risk was lower in women than in men (IRwomen: 6.73 vs. IRmen: 14.58 per 1000 person-years). While increase in absolute CVD risk associated with prevalent hypertension was lower in women than in men [WMD: −6.12, 95% confidence interval: (−9.84 to −2.40), P = 0.001], increase in absolute CVD risk associated with prevalent obesity [WMD: −4.25 (−9.11 to 0.61), P = 0.087], type-2 diabetes [WMD: −1.04 (−14.36 to 12.29), P = 0.879] and AF [WMD: 18.39 (−39.65 to 76.43), P = 0.535] did not significantly differ between the sexes. Using relative risk measures, prevalent hypertension [WMR: 1.49%, 95% confidence interval: (1.12–1.99), P = 0.006], type-2 diabetes [WMR: 1.73 (1.09–2.73), P = 0.019], and AF [WMR: 2.53 (1.12–5.70), P = 0.025] were all associated with higher CVD risk in women than in men. Conclusion Increase in absolute risk of developing CVD is higher in hypertensive men than in hypertensive women, but no substantial sex-related differences were observed among individuals with obesity, type-2 diabetes and AF. On a relative risk scale, comorbidities, in general, confer a higher CVD risk in women than in men.

Funder

Netherlands Heart Foundation

CVON SHE-PREDICTS-HF

CVON RED-CVD

CVON DOUBLE DOSE

leDucq Foundation

European Research Council

Publisher

Oxford University Press (OUP)

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