Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Gender disparities in cardiovascular risk burden in patients with ST-elevation myocardial infarctions as a first event
J. Schmucker1, A. Fach2, L. A. Mata Marín2, T. Retzlaff2, D. Garstka2, R. Osteresch2, R. Hambrecht3, H. Wienbergen4, für die Studiengruppe: BSR
1Klinik für Innere Medizin III, Klinikum Bremen-Mitte, Bremen; 2Klinik für Kardiologie und Angiologie, Klinikum Links der Weser, Bremen; 3Innere Medizin I, Klinikum Links der Weser, Bremen; 4Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Bremen;

Background: While female gender is associated with lower prevalence rates of cardiovascular disease especially in the young, it remains unclear whether this can mainly be attributed to their lower cardiovascular risk burden or to hormonal protection or genetic mechanisms. Aim of the present study was to compare the cumulative cardiovascular risk factor (CVRF) burden between men and women with ST-elevation-myocardial infarctions (STEMI) in registry-data stratified by age.

Methods: All patients from a regional STEMI-registry admitted between 2006 and 2020 with STEMI as a first event were included. Patients were assigned to four age groups: A1:<55 years, A2: 55-64 years, A3: 65-74 years, A4: ≥75 years. Six cardiovascular risk factors were included: obesity (body mass index≥30 kg/m²), diabetes mellitus, hypercholesterolemia, arterial hypertension, smoking and family history for coronary artery disease (CAD). Their prevalence rates  were compared between genders in an unadjusted , an age stratified and a multivariate adjusted analysis.

Results: Of a total of 7875 STEMI-patients analysed 5595 (71%) were male and 2280 (29%) female.  Female STEMI patients were on average 8.5 years older at time of STEMI (69.9±14 years vs. 61.4±13 years, p<0.01). The proportion of female patients was lowest in the young: A1: 17%, A2: 21%, A3: 29%, A4: 50%. Prior to age stratification unadjusted data showed higher prevalence rates of diabetes (21.6% vs. 16.4%, p<0.01) and arterial hypertension (65.8% vs. 53.1%, p<0.01) in women, while smoking rates (30.5% vs. 46.3%, p<0.01) and rates of a family history of CAD (13.8% vs. 18.1%, p<0.01) were higher in men. After stratification in age groups (A1-A4), women showed numerically higher prevalence rates across all risk-factors with the exception of smoking in patients in ≥75 years.  Overall, the likelihood of a high risk factor burden decreased with age (p(for trend)<0.01 in both sexes) and was (numerically) higher in all age-strata in women (table, left side). This higher risk factor burden for women could be confirmed in a multivariate model (further adjusted for age) except for young patients (<55 yrs. of age), where the disadvantage for women did not reach statistical significance (table, right side).

Table: Cumulative risk factor burden, women compared to men

   High CVRF-burden

(≥3 CVRF)

  Likelihood of a
very high CVRF-burden in women*
(≥4 CVRF )
   Men (%)  Women (%)  P  OR  95% CI  p
 A1
(<55 yrs.) 		  69.2  74.2  0.11  1.36  0.9-2.0  0.12
 A2
(55-64 yrs.) 		  60.2  67.7  0.02  1.74  1.1-2.7  0.02
 A3
(65-74 yrs.)		  50.2  62.5  <0.01  2.07  1.1-3.9  0.02
 A4
(≥75 yrs.)		  35.1  45.2  <0.01  2.71  1.0-7.8  0.06
 p (trend)  <0.01 <0.01 - - - -

 


* Multivariate analysis, compared to men=baseline
Conclusion: This age-stratified comparison of cumulative risk factor burden between women and men with STEMI had two main results: First, overall risk factor burden decreased with age and second, a high and very high risk factor burden was more likely in women. These results indicate that lower prevalence rates of CAD and STEMI in women cannot be sufficiently explained by a lower CVRF-burden, but rather by hormonal protection or gender-specific genetic mechanisms.
https://dgk.org/kongress_programme/jt2023/aP2069.html