Marzà-Florensa Anna, Gutierrez Laura, Gulayin Pablo, Vaartjes Ilonca, Grobbee Diederick E, Klipstein-Grobusch Kerstin, Irazola Vilma
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.
Int J Cardiol Cardiovasc Risk Prev. 2023 Jan 13;16:200172. doi: 10.1016/j.ijcrp.2023.200172. eCollection 2023 Mar.
Presence of multiple risk factors (RF) increases the risk for cardiovascular morbidity and mortality, and this is especially important in patients with coronary heart disease (CHD). The current study investigates sex differences in the presence of multiple cardiovascular RF in subjects with established CHD in the southern Cone of Latin America.
We analyzed cross-sectional data from the 634 participants aged 35-74 with CHD from the community-based CESCAS Study. We calculated the prevalence for counts of cardiometabolic (hypertension, dyslipidemia, obesity, diabetes) and lifestyle (current smoking, unhealthy diet, low physical activity, excessive alcohol consumption) RF. Differences in RF number between men and women were tested with age-adjusted Poisson regression. We identified the most common RF combinations among participants with ≥4 RF. We performed a subgroup analysis by educational level.
The prevalence of cardiometabolic RF ranged from 76.3% (hypertension) to 26.8% (diabetes), and the prevalence of lifestyle RF from 81.9% (unhealthy diet) to 4.3% (excessive alcohol consumption). Obesity, central obesity, diabetes and low physical activity were more common in women, while excessive alcohol consumption and unhealthy diet were more common in men. Close to 85% of women and 81.5% of men presented with ≥4 RF. Women presented with a higher number of overall (relative risk (RR) 1.05, 95% CI 1.02-1.08) and cardiometabolic RF (1.17, 1.09-1.25). These sex differences were found in participants with primary education (RR women overall RF 1.08, 1.00-1.15, cardiometabolic RF 1.23, 1.09-1.39), but were diluted in those with higher educational attainment. The most common RF combination was hypertension/dyslipidemia/obesity/unhealthy diet.
Overall, women showed a higher burden of multiple cardiovascular RF. Sex differences persisted in participants with low educational attainment, and women with low educational level had the highest RF burden.
多种风险因素（RF）的存在会增加心血管疾病发病和死亡的风险，这在冠心病（CHD）患者中尤为重要。本研究调查了拉丁美洲南锥体地区确诊冠心病患者中多种心血管风险因素存在情况的性别差异。
我们分析了基于社区的CESCAS研究中634名年龄在35 - 74岁的冠心病参与者的横断面数据。我们计算了心血管代谢（高血压、血脂异常、肥胖、糖尿病）和生活方式（当前吸烟、不健康饮食、低体力活动、过量饮酒）风险因素的计数患病率。使用年龄调整的泊松回归检验男性和女性之间风险因素数量的差异。我们确定了有≥4个风险因素的参与者中最常见的风险因素组合。我们按教育水平进行了亚组分析。
心血管代谢风险因素的患病率从76.3%（高血压）到26.8%（糖尿病）不等，生活方式风险因素的患病率从81.9%（不健康饮食）到4.3%（过量饮酒）不等。肥胖、中心性肥胖、糖尿病和低体力活动在女性中更为常见，而过量饮酒和不健康饮食在男性中更为常见。近85%的女性和81.5%的男性有≥4个风险因素。女性的总体风险因素数量（相对风险（RR）1.05，95%置信区间1.02 - 1.08）和心血管代谢风险因素数量（1.17，1.09 - 1.25）更高。这些性别差异在小学教育程度的参与者中存在（RR女性总体风险因素1.08，1.00 - 1.15，心血管代谢风险因素1.23，1.09 - 1.39），但在教育程度较高的参与者中被淡化。最常见的风险因素组合是高血压/血脂异常/肥胖/不健康饮食。
总体而言，女性显示出更高的多种心血管风险因素负担。性别差异在教育程度低的参与者中持续存在，教育程度低的女性风险因素负担最高。
