Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic; Department of Medicine II, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic.
Department of Internal Medicine, Charles University in Prague, Second Faculty of Medicine, Prague, Czech Republic; Laboratory for Atherosclerosis Research, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Int J Cardiol. 2019 Jul 1;286:214-219. doi: 10.1016/j.ijcard.2019.01.039. Epub 2019 Jan 18.
Cardiovascular disease (CVD) is the leading cause of death in women in developed countries. The traditional modifiable risk factors are able to explain the majority of CVD mortality. The aim of this review is to analyze gender-specific aspects of major conventional cardiovascular risk factors and to assess whether they have the same impact on CVD in women. Cigarette smoking remains the single largest preventable cause of cardiovascular morbidity and premature death worldwide. Women smoke less than men; however, smoking seems to be more harmful in women, particularly in oral contraceptive users. Obesity in the general population is more prevalent in women. Visceral adiposity is associated with insulin resistance and a higher risk of developing cardiovascular disease. Life expectancy in female diabetic patients is shorter than in men with diabetes; women with diabetes are also at higher risk of developing cardiovascular events. Changes of main lipid parameters in women are frequently associated with their hormonal status and/or hormonal treatment. Hypertension is highly prevalent in post-menopausal women and carries a higher risk of developing left ventricular hypertrophy, which, together with a greater increase in vascular and myocardial stiffness, results in a higher incidence of heart failure with preserved ejection fraction and a higher risk of developing stroke. The risk of abdominal aortic rupture is substantially higher in women. In conclusion, smoking, diabetes and hypertension seem to be more harmful in women. Therefore, the question is whether there should not be lower thresholds for initiating drug treatment in women with diabetes and hypertension.
心血管疾病（CVD）是发达国家女性死亡的主要原因。传统的可改变风险因素能够解释大部分 CVD 死亡率。本综述旨在分析主要常规心血管风险因素的性别特异性方面，并评估它们对女性 CVD 的影响是否相同。吸烟仍然是全世界可预防的心血管发病率和过早死亡的最大单一原因。女性吸烟少于男性；然而，吸烟对女性的危害似乎更大，尤其是在口服避孕药使用者中。肥胖在普通人群中更为普遍。内脏肥胖与胰岛素抵抗和更高的心血管疾病风险相关。女性糖尿病患者的预期寿命比男性糖尿病患者短；女性糖尿病患者也有更高的心血管事件风险。女性主要血脂参数的变化通常与她们的激素状态和/或激素治疗有关。绝经后妇女高血压患病率很高，发生左心室肥厚的风险更高，这与血管和心肌僵硬的更大增加一起，导致射血分数保留的心力衰竭发生率更高，中风风险更高。女性腹主动脉破裂的风险显著增加。总之，吸烟、糖尿病和高血压对女性的危害似乎更大。因此，问题是女性是否不应该有更低的糖尿病和高血压药物治疗起始阈值。
