Towfighi Amytis, Zheng Ling, Ovbiagele Bruce
Division of Stroke and Critical Care, Department of Neurology, University of Southern California, Los Angeles, CA 90033, USA.
Arch Intern Med. 2009 Oct 26;169(19):1762-6. doi: 10.1001/archinternmed.2009.318.
While recent data indicate that stroke prevalence in women at midlife is double that of similarly aged men in the United States, little is known about current sex-specific trends in symptomatic cardiovascular disease. This study aimed to determine sex-specific midlife prevalence of myocardial infarction (MI) and risk of future coronary heart disease.
We assessed the sex-specific MI prevalence and the Framingham coronary risk score (FCRS) among US adults aged 35 to 54 years who participated in the National Health and Nutrition Examination Surveys (NHANES), cross-sectional, nationally representative surveys, during 1988 to 1994 and 1999 to 2004.
In both epochs, men aged 35 to 54 years had a higher prevalence of MI than similarly aged women, but the gap narrowed in recent years as MI prevalence decreased among men and increased among women (2.5% vs 0.7% in NHANES 1988-1994 [P < .01] and 2.2% vs 1.0% in NHANES 1999-2004 [P < .01]). Among men, the mean FCRS showed an improving trend (8.6% in NHANES 1988-1994 vs 8.1% in NHANES 1999-2004 [P = .07]), while among women, the mean FCRS worsened (3.0% in NHANES 1988-1994 vs 3.3% in NHANES 1999-2004 [P = .02]). Temporal trends in FCRS components revealed that men had more improvements in vascular risk factors than women, but diabetes mellitus prevalence increased in both sexes.
Over the past 2 decades, MI prevalence has increased among midlife women, while declining among similarly aged men. Also, although the risk of future hard cardiovascular events remains higher in midlife men compared with midlife women, the gap has narrowed in recent years. Greater emphasis on vascular risk factor control in midlife women might help mitigate this worrisome trend.
虽然近期数据表明，在美国，中年女性的中风患病率是同龄男性的两倍，但对于有症状心血管疾病当前的性别特异性趋势却知之甚少。本研究旨在确定心肌梗死（MI）的性别特异性中年患病率以及未来冠心病的风险。
我们评估了参加1988年至1994年以及1999年至2004年全国健康和营养检查调查（NHANES）的35至54岁美国成年人的性别特异性MI患病率和弗雷明汉冠心病风险评分（FCRS），这是具有全国代表性的横断面调查。
在两个时期，35至54岁男性的MI患病率均高于同龄女性，但近年来随着男性MI患病率下降和女性MI患病率上升，这一差距缩小（1988 - 1994年NHANES中为2.5%对0.7%[P <.01]，1999 - 2004年NHANES中为2.2%对1.0%[P <.01]）。在男性中，平均FCRS呈改善趋势（1988 - 1994年NHANES中为8.6%，1999 - 2004年NHANES中为8.1%[P =.07]），而在女性中，平均FCRS则恶化（1988 - 1994年NHANES中为3.0%，1999 - 2004年NHANES中为3.3%[P =.02]）。FCRS各组成部分的时间趋势显示，男性在血管危险因素方面的改善比女性更多，但糖尿病患病率在两性中均有所增加。
在过去20年中，中年女性的MI患病率有所上升，而同龄男性的MI患病率则有所下降。此外，尽管中年男性未来发生严重心血管事件的风险仍高于中年女性，但近年来这一差距已缩小。更加重视中年女性血管危险因素的控制可能有助于缓解这一令人担忧的趋势。
