Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Epidemiology, Harvard School of Public Health, Boston, MA, US.
Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Radiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Institute of Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, US.
BMJ. 2014 Nov 17;349:g5992. doi: 10.1136/bmj.g5992.
To evaluate differences in first manifestations of cardiovascular disease between men and women in a competing risks framework.
Prospective population based cohort study.
People living in the community in Rotterdam, the Netherlands.
8419 participants (60.9% women) aged ≥ 55 and free from cardiovascular disease at baseline.
First diagnosis of coronary heart disease (myocardial infarction, revascularisation, and coronary death), cerebrovascular disease (stroke, transient ischaemic attack, and carotid revascularisation), heart failure, or other cardiovascular death; or death from non-cardiovascular causes. Data were used to calculate lifetime risks of cardiovascular disease and its first incident manifestations adjusted for competing non-cardiovascular death.
During follow-up of up to 20.1 years, 2888 participants developed cardiovascular disease (826 coronary heart disease, 1198 cerebrovascular disease, 762 heart failure, and 102 other cardiovascular death). At age 55, overall lifetime risks of cardiovascular disease were 67.1% (95% confidence interval 64.7% to 69.5%) for men and 66.4% (64.2% to 68.7%) for women. Lifetime risks of first incident manifestations of cardiovascular disease in men were 27.2% (24.1% to 30.3%) for coronary heart disease, 22.8% (20.4% to 25.1%) for cerebrovascular disease, 14.9% (13.3% to 16.6%) for heart failure, and 2.3% (1.6% to 2.9%) for other deaths from cardiovascular disease. For women the figures were 16.9% (13.5% to 20.4%), 29.8% (27.7% to 31.9%), 17.5% (15.9% to 19.2%), and 2.1% (1.6% to 2.7%), respectively. Differences in the number of events that developed over the lifespan in women compared with men (per 1000) were -7 for any cardiovascular disease, -102 for coronary heart disease, 70 for cerebrovascular disease, 26 for heart failure, and -1 for other cardiovascular death; all outcomes manifested at a higher age in women. Patterns were similar when analyses were restricted to hard atherosclerotic cardiovascular disease outcomes, but absolute risk differences between men and women were attenuated for both coronary heart disease and stroke.
At age 55, though men and women have similar lifetime risks of cardiovascular disease, there are considerable differences in the first manifestation. Men are more likely to develop coronary heart disease as a first event, while women are more likely to have cerebrovascular disease or heart failure as their first event, although these manifestations appear most often at older ages.
在竞争风险框架下评估男性和女性心血管疾病首发表现的差异。
前瞻性基于人群的队列研究。
荷兰鹿特丹社区居民。
8419 名参与者（60.9%为女性），年龄≥55 岁，基线时无心血管疾病。
首次诊断为冠心病（心肌梗死、血运重建和冠状动脉死亡）、脑血管疾病（中风、短暂性脑缺血发作和颈动脉血运重建）、心力衰竭或其他心血管死亡；或非心血管原因死亡。数据用于计算心血管疾病及其首发事件表现的终生风险，同时调整了竞争的非心血管死亡因素。
在长达 20.1 年的随访期间，2888 名参与者发生了心血管疾病（826 例冠心病、1198 例脑血管疾病、762 例心力衰竭和 102 例其他心血管死亡）。在 55 岁时，男性的总体心血管疾病终生风险为 67.1%（95%置信区间 64.7%至 69.5%），女性为 66.4%（64.2%至 68.7%）。男性首发心血管疾病的表现中，冠心病的终生风险为 27.2%（24.1%至 30.3%），脑血管疾病为 22.8%（20.4%至 25.1%），心力衰竭为 14.9%（13.3%至 16.6%），其他心血管疾病死亡为 2.3%（1.6%至 2.9%）。女性的数字分别为 16.9%（13.5%至 20.4%）、29.8%（27.7%至 31.9%）、17.5%（15.9%至 19.2%）和 2.1%（1.6%至 2.7%）。与男性相比，女性在整个生命周期中发生的心血管疾病事件数量（每 1000 例）差异为-7（任何心血管疾病）、-102（冠心病）、70（脑血管疾病）、26（心力衰竭）和-1（其他心血管疾病死亡）；所有结局在女性中都出现在更高的年龄。当分析仅限于硬动脉粥样硬化性心血管疾病结局时，结果相似，但男性和女性之间的冠心病和中风的绝对风险差异有所减弱。
在 55 岁时，尽管男性和女性的心血管疾病终生风险相似，但首发表现存在很大差异。男性更有可能首先发生冠心病，而女性更有可能首先发生脑血管疾病或心力衰竭，尽管这些表现往往出现在年龄更大的时候。
