Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Mathematics, University of Bergen, Norway.
JAMA Intern Med. 2016 Nov 1;176(11):1673-1679. doi: 10.1001/jamainternmed.2016.5451.
It is not clear to what extent the higher incidence of coronary heart disease (CHD) in men vs women is explained by differences in risk factor levels because few studies have presented adjusted risk estimates for sex. Moreover, the increase in risk of CHD in postmenopausal women, possibly hormone related, may eventually eliminate the sex contrast in risk, but age-specific risk estimates are scarce.
To quantify the difference in risk of incident myocardial infarction (MI) between men and women.
DESIGN, SETTING AND PARTICIPANTS: Population-based prospective study from Tromsø, Norway, comprising 33 997 individuals (51% women). Median follow-up time during ages 35 to 102 years was 17.6 years. Incidence rates (IRs) and incidence rate ratios (IRRs, relative risk) of MI were calculated in Poisson regression analysis of person-years at risk. The data analysis was performed in November 2015.
Sex, age, birth cohort, serum lipid levels, blood pressure, lifestyle factors, diabetes.
Incident MI.
A total of 2793 individuals (886 women) received a diagnosis of MI during follow-up in the period 1979 through 2012. The IR increased with age in both sexes, with lower rates for women until age 95 years. Adjusted for age and birth cohort, the overall IRR for men vs women was 2.72 (95% CI, 2.50-2.96). Adjustment for high-density lipoprotein cholesterol and total cholesterol levels had the strongest impact on the risk estimate for sex, followed by diastolic blood pressure and smoking. However, the sex difference remained substantial even after adjustment for these factors (IRR, 2.07; 95% CI, 1.89-2.26). Men had higher risk throughout life, but the IRRs decreased with age (3.64 [95% CI, 2.85-4.65], 2.00 [95% CI, 1.76-2.28], and 1.66 [95% CI, 1.42-1.95] for age groups 35-54, 55-74, and 75-94 years, respectively). Adjustment for systolic blood pressure, diabetes, body mass index, and physical activity had no notable impact.
The observed sex contrast in risk of MI cannot be explained by differences in established CHD risk factors. The gender gap persisted throughout life but declined with age as a result of a more pronounced flattening of risk level changes in middle-aged men. The minor changes in IRs when moving from premenopausal to postmenopausal age in women make it unlikely that changes in female hormone levels influence the risk of MI.
目前尚不清楚男性冠心病（CHD）发病率高于女性的程度在多大程度上可以用风险因素水平的差异来解释，因为很少有研究对性别进行了调整后的风险估计。此外，绝经后女性患 CHD 的风险增加（可能与激素有关）最终可能会消除风险方面的性别差异，但特定年龄的风险估计却很少。
量化男性和女性发生心肌梗死（MI）的风险差异。
设计、地点和参与者：这是一项来自挪威特罗姆瑟的基于人群的前瞻性研究，共纳入 33997 名个体（51%为女性）。35 岁至 102 岁期间的中位随访时间为 17.6 年。采用泊松回归分析计算个体风险年的发病率（IR）和发病率比（IRR，相对风险）。数据分析于 2015 年 11 月进行。
性别、年龄、出生队列、血清脂质水平、血压、生活方式因素、糖尿病。
新发 MI。
在 1979 年至 2012 年期间的随访期间，共有 2793 名个体（886 名女性）被诊断为 MI。在两性中，IR 随年龄增长而增加，直到 95 岁，女性的发病率较低。在调整年龄和出生队列后，男性与女性的整体 IRR 为 2.72（95%CI，2.50-2.96）。高密度脂蛋白胆固醇和总胆固醇水平的调整对性别风险估计的影响最大，其次是舒张压和吸烟。然而，即使在调整了这些因素后，性别差异仍然很大（IRR，2.07；95%CI，1.89-2.26）。男性一生的风险都较高，但 IRR 随年龄增长而下降（35-54 岁、55-74 岁和 75-94 岁年龄组的 IRR 分别为 3.64[95%CI，2.85-4.65]、2.00[95%CI，1.76-2.28]和 1.66[95%CI，1.42-1.95]）。调整收缩压、糖尿病、体重指数和体力活动对结果没有显著影响。
MI 风险的观察到的性别差异不能用已确定的 CHD 风险因素的差异来解释。这种性别差距贯穿一生，但随着年龄的增长而缩小，原因是中年男性风险水平变化的幅度更加明显。女性从绝经前到绝经后年龄的 IR 变化较小，这表明女性激素水平的变化不太可能影响 MI 的风险。
