Lopez-Lopez Jose Patricio, Toro Martin Rebolledo-Del, Martinez-Bello Daniel, Garcia-Peña Ángel A, O'Donovan Gary, Perez-Mayorga Maritza, Otero Johanna, Rangarajan Sumathy, Yusuf Salim, Lopez-Jaramillo Patricio
Masira Research Institute, Universidad de Santander (UDES), Bucaramanga, Colombia.
Internal Medicine Department, Cardiology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia.
Glob Heart. 2024 Jan 24;19(1):10. doi: 10.5334/gh.1289. eCollection 2024.
Controversies exist on whether the presence of cardiovascular risk factors and their association with major cardiovascular events (MACE) is different between men and women. Most of the evidence comes from high-income countries, hindering extrapolation of sociocultural and demographic factors of other regions.
To evaluate sex differences in the prevalence of cardiovascular risk factors and the incidence of MACE and diabetes in Colombian adults.
We performed a survival analysis from women and men aged 35-70 belonging to the Prospective Urban Rural Epidemiology-Colombia prospective study. Incidence rates for MACE composite (myocardial infarction, stroke, heart failure, death) and each outcome and diabetes were calculated. Kaplan-Meier curves and log-rank tests were performed. The association between demographic, behavioral, and metabolic variables with MACE and diabetes were evaluated with Cox proportional hazards models.
7,552 participants (50±9.7 years) were included; 64% were women. Women had higher hypertension prevalence, body mass index, levels of total cholesterol, LDL-c, and HDL-c but lower triglycerides levels. Women were more sedentary but fewer smokers or active alcohol consumers and had higher educational levels. After 12-year mean follow-up (SD 2.3), the incidence rate of MACE composite was higher in men [4.2 (3.6-4.9) vs. 3.2 (2.8-3.7) cases per 1000 person-years]. Diabetes had the greatest association with MACE (HR = 2.63 95%CI:1.85;3.76), followed by hypertension (HR = 1.75 95%CI:1.30;2.35), low relative grip strength (HR = 1.53 95%CI:1.15;2.02), smoking (HR = 1.47 95%CI: 1.11;1.93), low physical activity (HR = 1.42 95%CI: 1.03;1.96). When evaluating risk factors by sex, only an increased waist-to-hip ratio was more strongly associated with MACE in men (p-interaction <0.05).
The composite MACE outcome was higher in men despite having a lower overall burden of risk factors. The risk factors contribution was similar, leading us to reconsider the need to carrying out differentiated cardiovascular risk prevention and management campaigns, at least in our region.
心血管危险因素的存在及其与主要心血管事件（MACE）的关联在男性和女性之间是否存在差异存在争议。大多数证据来自高收入国家，这阻碍了对其他地区社会文化和人口因素的推断。
评估哥伦比亚成年人中心血管危险因素患病率、MACE和糖尿病发病率的性别差异。
我们对来自哥伦比亚城乡前瞻性流行病学前瞻性研究的35至70岁的男性和女性进行了生存分析。计算了MACE综合指标（心肌梗死、中风、心力衰竭、死亡）以及每种结局和糖尿病的发病率。进行了Kaplan-Meier曲线和对数秩检验。使用Cox比例风险模型评估人口统计学、行为和代谢变量与MACE和糖尿病之间的关联。
纳入了7552名参与者（50±9.7岁）；64%为女性。女性的高血压患病率、体重指数、总胆固醇、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇水平较高，但甘油三酯水平较低。女性久坐不动的时间更长，但吸烟者或积极饮酒者较少，且教育水平较高。经过12年的平均随访（标准差2.3），男性的MACE综合发病率更高[每1000人年4.2（3.6-4.9）例对3.2（2.8-3.7）例]。糖尿病与MACE的关联最大（HR = 2.63，95%CI：1.85；3.76），其次是高血压（HR = 1.75，95%CI：1.30；2.35）、相对握力低（HR = 1.53，95%CI：1.15；2.02）、吸烟（HR = 1.47，95%CI：1.11；1.93）、身体活动不足（HR = 1.42，95%CI：1.03；1.96）。按性别评估危险因素时，只有腰臀比增加在男性中与MACE的关联更强（p交互作用<0.05）。
尽管男性的总体危险因素负担较低，但MACE综合结局在男性中更高。危险因素的贡献相似，这使我们重新考虑至少在我们地区开展差异化心血管风险预防和管理活动的必要性。
