According to the results of a large prospective study, women across the globe are less likely than men to either develop or die from heart disease.
A team from McMaster University in Ontario, Canada, followed 202,072 individuals in 27 countries, aged between 35 and 70 from urban and rural communities for a median of 9.5 years. The researchers systematically examined the differences in risk factors, treatments, cardiovascular disease incidence and mortality among people from high-income, middle-income and low-income countries. Using two different cardiovascular risk factor scoring systems (INTERHEART and Framingham), women had a lower cardiovascular risk burden and primary prevention strategies such as healthy lifestyle behaviours and medicine use were more common in women.
This resulted in a lower incidence of cardiovascular disease in women compared to men (4.1% vs 6.4%) as well as all-cause mortality (4.5% vs 7.4%). Interestingly, however, secondary prevention treatments such as cardiac investigations and coronary revascularisations were less frequent in women among those with existing cardiovascular disease. Despite this lower level of secondary prevention interventions, women still had a lower incidence of recurrent cardiovascular events than men (20% vs 27.7%) and a significantly lower 30-mortality after such events (22% vs 28%) and the authors were unable to account for these differences.
Nevertheless, an important finding was that there were larger gaps in disease management and outcomes in both women and men in poorer compared with richer countries.
Walli-Attaei M et al. Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet 2020;May 20.