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Metabolic, Behavioural, and Psychosocial Risk Factors and Cardiovascular Disease in Women Compared With Men in 21 High-Income, Middle-Income, and Low-Income Countries: An Analysis of the Pure Study Publisher Pubmed



Walliattaei M1 ; Rosengren A2 ; Rangarajan S1 ; Breet Y3 ; Abdulrazak S4 ; Sharief WA5 ; Alhabib KF6 ; Avezum A7 ; Chifamba J8 ; Diaz R9 ; Gupta R10 ; Hu B11 ; Iqbal R12 ; Ismail R13 Show All Authors
Authors
  1. Walliattaei M1
  2. Rosengren A2
  3. Rangarajan S1
  4. Breet Y3
  5. Abdulrazak S4
  6. Sharief WA5
  7. Alhabib KF6
  8. Avezum A7
  9. Chifamba J8
  10. Diaz R9
  11. Gupta R10
  12. Hu B11
  13. Iqbal R12
  14. Ismail R13
  15. Kelishadi R14
  16. Khatib R15
  17. Lang X11
  18. Li S11
  19. Lopezjaramillo P16
  20. Mohan V17
  21. Oguz A18
  22. Palileovillanueva LM19
  23. Poltynzaradna K20
  24. R SP21
  25. Pinnaka LVM22
  26. Seron P23
  27. Teo K1
  28. Verghese ST24
  29. Wielgosz A25
  30. Yeates K26
  31. Yusuf R27
  32. Anand SS1
  33. Yusuf S1
Show Affiliations
Authors Affiliations
  1. 1. Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
  2. 2. Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
  3. 3. Hypertension in Africa Research Team (HART) and MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
  4. 4. Faculty of Medicine, Universiti Teknologi MARA (UiTM), Cardio Vascular and Lungs Research Institute (CaVaLRI), Selangor, Malaysia
  5. 5. Medical Education & Research Department, Medical College, University of Sharjah, Sharjah, United Arab Emirates
  6. 6. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  7. 7. International Research Center, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil
  8. 8. Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
  9. 9. Estudios Clinicos Latinoamerica (ECLA), Santa Fe, Rosario, Argentina
  10. 10. Eternal Heart Care Centre & Research Institute, Jaipur, India
  11. 11. Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, China
  12. 12. Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
  13. 13. Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Medical Centre, Kuala Lumpur, Malaysia
  14. 14. Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  15. 15. Institute for Community and Public Health, Birzeit University, Birzeit, Palestine
  16. 16. Masira Research Institute, Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
  17. 17. Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
  18. 18. Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
  19. 19. College of Medicine, University of the Philippines Manila, Manila, Philippines
  20. 20. Department of Population Health, Wroclaw Medical University, Wroclaw, Poland
  21. 21. SUT Academy of Medical Sciences, Vattapara, Kerala, Trivandrum, India
  22. 22. Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
  23. 23. Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
  24. 24. Department of Physiology, St John's Medical College and Hospital, Bangalore, India
  25. 25. Department of Medicine, University of Ottawa, Ottawa, ON, Canada
  26. 26. Department of Medicine, Queen's University, Kingston, ON, Canada
  27. 27. School of Life Sciences, Independent University, Dhaka, Bangladesh

Source: The Lancet Published:2022


Abstract

Background: There is a paucity of data on the prevalence of risk factors and their associations with incident cardiovascular disease in women compared with men, especially from low-income and middle-income countries. Methods: In the Prospective Urban Rural Epidemiological (PURE) study, we enrolled participants from the general population from 21 high-income, middle-income, and low-income countries and followed them up for approximately 10 years. We recorded information on participants’ metabolic, behavioural, and psychosocial risk factors. For this analysis, we included participants aged 35–70 years at baseline without a history of cardiovascular disease, with at least one follow-up visit. The primary outcome was a composite of major cardiovascular events (cardiovascular disease deaths, myocardial infarction, stroke, and heart failure). We report the prevalence of each risk factor in women and men, their hazard ratios (HRs), and population-attributable fractions (PAFs) associated with major cardiovascular disease. The PURE study is registered with ClinicalTrials.gov, NCT03225586. Findings: In this analysis, we included 155 724 participants enrolled and followed-up between Jan 5, 2005, and Sept 13, 2021, (90 934 [58·4%] women and 64 790 [41·6%] men), with a median follow-up of 10·1 years (IQR 8·5–12·0). At study entry, the mean age of women was 49·8 years (SD 9·7) compared with 50·8 years (9·8) in men. As of data cutoff (Sept 13, 2021), 4280 major cardiovascular disease events had occurred in women (age-standardised incidence rate of 5·0 events [95% CI 4·9–5·2] per 1000 person-years) and 4911 in men (8·2 [8·0–8·4] per 1000 person-years). Compared with men, women presented with a more favourable cardiovascular risk profile, especially at younger ages. The HRs for metabolic risk factors were similar in women and men, except for non-HDL cholesterol, for which high non-HDL cholesterol was associated with an HR for major cardiovascular disease of 1·11 (95% CI 1·01–1·21) in women and 1·28 (1·19–1·39) in men, with a consistent pattern for higher risk among men than among women with other lipid markers. Symptoms of depression had a HR of 1·09 (0·98–1·21) in women and 1·42 (1·25–1·60) in men. By contrast, consumption of a diet with a PURE score of 4 or lower (score ranges from 0 to 8), was more strongly associated with major cardiovascular disease in women (1·17 [1·08–1·26]) than in men (1·07 [0·99–1·15]). The total PAFs associated with behavioural and psychosocial risk factors were greater in men (15·7%) than in women (8·4%) predominantly due to the larger contribution of smoking to PAFs in men (ie, 1·3% [95% CI 0·5–2·1] in women vs 10·7% [8·8–12·6] in men). Interpretation: Lipid markers and depression are more strongly associated with the risk of cardiovascular disease in men than in women, whereas diet is more strongly associated with the risk of cardiovascular disease in women than in men. The similar associations of other risk factors with cardiovascular disease in women and men emphasise the importance of a similar strategy for the prevention of cardiovascular disease in men and women. Funding: Funding sources are listed at the end of the Article. © 2022 Elsevier Ltd
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