How Does Cardiovascular Disease First Present in Women and Men? Incidence of 12 Cardiovascular Diseases in a Contemporary Cohort of 1,937,360 People

Abstract

Background: Given the recent declines in heart attack and stroke incidence, it is unclear how women and men differ in first lifetime presentations of cardiovascular diseases (CVDs). We compared the incidence of 12 cardiac, cerebrovascular, and peripheral vascular diseases in women and men at different ages.

Methods and results: We studied 1 937 360 people, aged ≥ 30 years and free from diagnosed CVD at baseline (51% women), using linked electronic health records covering primary care, hospital admissions, acute coronary syndrome registry, and mortality (Cardiovascular Research Using LInked Bespoke Studies and Electronic Records [CALIBER] research platform). During 6 years median follow-up between 1997 and 2010, 114 859 people experienced an incident cardiovascular diagnosis, the majority (66%) of which were neither myocardial infarction nor ischemic stroke. Associations of male sex with initial diagnoses of CVD, however, varied from strong (age-adjusted hazard ratios, 3.6-5.0) for abdominal aortic aneurysm, myocardial infarction, and unheralded coronary death (particularly >60 years), through modest (hazard ratio, 1.5-2.0) for stable angina, ischemic stroke, peripheral arterial disease, heart failure, and cardiac arrest, to weak (hazard ratio <1.5) for transient ischemic attack, intracerebral hemorrhage, and unstable angina, and inverse (0.69) for subarachnoid hemorrhage (all P<0.001).

Conclusions: The majority of initial presentations of CVD are neither myocardial infarction nor ischemic stroke, yet most primary prevention studies focus on these presentations. Sex has differing associations with different CVDs, with implications for risk prediction and management strategies.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01164371.

Keywords: aging; cardiovascular diseases; electronic health records; incidence; population; risk factors; sex.

Figure 1.

Age and sex distribution of 60 155 events in men and 54 704 in women representing the initial presentation of a wide range of CVDs. CHD indicates coronary heart disease; CVD, cardiovascular disease; NOS, not otherwise specified; and SCD, sudden cardiac death.

Figure 2.

Hazard ratios of men in comparison with women for initial presentation of 12 different cardiovascular diseases among a population of 1.93 million adults. CHD indicates coronary heart disease; CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; NOS, not otherwise specified; and SCD, sudden cardiac death.

Figure 3.

Hazard ratios for men in comparison with women for initial presentation of 12 cardiovascular diseases by baseline age group among a population of 1.93 million adults. CHD indicates coronary heart disease; CI, confidence interval; HR, hazard ratio; NOS, not otherwise specified; and SCD, sudden cardiac death.