Background

There is a paucity of data on the prevalence of risk factors and their associations with incident cardiovascular disease in women compared with men, especially from low-income and middle-income countries.

Methods

In the Prospective Urban Rural Epidemiological (PURE) study, we enrolled participants from the general population from 21 high-income, middle-income, and low-income countries and followed them up for approximately 10 years. We recorded information on participants’ metabolic, behavioural, and psychosocial risk factors. For this analysis, we included participants aged 35–70 years at baseline without a history of cardiovascular disease, with at least one follow-up visit. The primary outcome was a composite of major cardiovascular events (cardiovascular disease deaths, myocardial infarction, stroke, and heart failure). We report the prevalence of each risk factor in women and men, their hazard ratios (HRs), and population-attributable fractions (PAFs) associated with major cardiovascular disease. The PURE study is registered with ClinicalTrials.gov, NCT03225586.

Findings

In this analysis, we included 155 724 participants enrolled and followed-up between Jan 5, 2005, and Sept 13, 2021, (90 934 [58·4%] women and 64 790 [41·6%] men), with a median follow-up of 10·1 years (IQR 8·5–12·0). At study entry, the mean age of women was 49·8 years (SD 9·7) compared with 50·8 years (9·8) in men. As of data cutoff (Sept 13, 2021), 4280 major cardiovascular disease events had occurred in women (age-standardised incidence rate of 5·0 events [95% CI 4·9–5·2] per 1000 person-years) and 4911 in men (8·2 [8·0–8·4] per 1000 person-years). Compared with men, women presented with a more favourable cardiovascular risk profile, especially at younger ages. The HRs for metabolic risk factors were similar in women and men, except for non-HDL cholesterol, for which high non-HDL cholesterol was associated with an HR for major cardiovascular disease of 1·11 (95% CI 1·01–1·21) in women and 1·28 (1·19–1·39) in men, with a consistent pattern for higher risk among men than among women with other lipid markers. Symptoms of depression had a HR of 1·09 (0·98–1·21) in women and 1·42 (1·25–1·60) in men. By contrast, consumption of a diet with a PURE score of 4 or lower (score ranges from 0 to 8), was more strongly associated with major cardiovascular disease in women (1·17 [1·08–1·26]) than in men (1·07 [0·99–1·15]). The total PAFs associated with behavioural and psychosocial risk factors were greater in men (15·7%) than in women (8·4%) predominantly due to the larger contribution of smoking to PAFs in men (ie, 1·3% [95% CI 0·5–2·1] in women vs 10·7% [8·8–12·6] in men).

Interpretation

Lipid markers and depression are more strongly associated with the risk of cardiovascular disease in men than in women, whereas diet is more strongly associated with the risk of cardiovascular disease in women than in men. The similar associations of other risk factors with cardiovascular disease in women and men emphasise the importance of a similar strategy for the prevention of cardiovascular disease in men and women.

Funding

Funding sources are listed at the end of the Article.

中文翻译：

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在 21 个高收入、中等收入和低收入国家中，女性与男性的代谢、行为和心理社会风险因素以及心血管疾病：PURE 研究分析

背景

与男性相比，女性中危险因素的流行率及其与心血管疾病发生率的关系的数据很少，尤其是来自低收入和中等收入国家的数据。

方法

在前瞻性城乡流行病学 (PURE) 研究中，我们招募了来自 21 个高收入、中等收入和低收入国家的普通人群的参与者，并对他们进行了大约 10 年的随访。我们记录了参与者的代谢、行为和社会心理风险因素的信息。在这项分析中，我们纳入了基线年龄为 35-70 岁且无心血管疾病史且至少进行过一次随访的参与者。主要结局是主要心血管事件（心血管疾病死亡、心肌梗死、中风和心力衰竭）的复合。我们报告了与主要心血管疾病相关的女性和男性中每个风险因素的流行率、风险比 (HR) 和人群归因分数 (PAF)。PURE 研究已在 ClinicalTrials.gov 注册，

发现

在这项分析中，我们纳入了 2005 年 1 月 5 日至 2021 年 9 月 13 日期间登记和随访的 155 724 名参与者（90 934 [58·4%] 女性和 64 790 [41·6%] 男性），中位随访 10·1 年（IQR 8·5–12·0）。进入研究时，女性的平均年龄为 49·8 岁 (SD 9·7)，而男性为 50·8 岁 (9·8)。截至数据截止（2021 年 9 月 13 日），女性发生了 4280 起主要心血管疾病事件（年龄标准化发病率为 5·0 事件 [95% CI 4·9-5·2] 每 1000 人年）和男性 4911 人（每 1000 人年 8·2 [8·0–8·4]）。与男性相比，女性的心血管风险状况更佳，尤其是在年轻时。除了非高密度脂蛋白胆固醇外，女性和男性的代谢风险因素的 HR 相似，其中高非 HDL 胆固醇与女性主要心血管疾病的 HR 为 1·11 (95% CI 1·01-1·21) 和男性为 1·28 (1·19-1·39) 相关，与具有其他脂质标志物的女性相比，男性的风险更高。女性抑郁症状的 HR 为 1·09 (0·98–1·21)，男性为 1·42 (1·25–1·60)。相比之下，PURE 评分为 4 分或更低（评分范围为 0 到 8 分）的饮食与女性的主要心血管疾病（1·17 [1·08-1·26]）的相关性比女性更强烈。男性（1·07 [0·99–1·15]）。男性与行为和心理社会风险因素相关的总 PAF (15·7%) 高于女性 (8·4%)，这主要是因为吸烟对男性 PAF 的贡献更大（即 1·3% [95女性的 % CI 0·5–2·1] 女性抑郁症状的 HR 为 1·09 (0·98–1·21)，男性为 1·42 (1·25–1·60)。相比之下，PURE 评分为 4 分或更低（评分范围为 0 到 8 分）的饮食与女性的主要心血管疾病（1·17 [1·08-1·26]）的相关性比女性更强烈。男性（1·07 [0·99–1·15]）。男性与行为和心理社会风险因素相关的总 PAF (15·7%) 高于女性 (8·4%)，这主要是因为吸烟对男性 PAF 的贡献更大（即 1·3% [95女性的 % CI 0·5–2·1] 女性抑郁症状的 HR 为 1·09 (0·98–1·21)，男性为 1·42 (1·25–1·60)。相比之下，PURE 评分为 4 分或更低（评分范围为 0 到 8 分）的饮食与女性的主要心血管疾病（1·17 [1·08-1·26]）的相关性比女性更强烈。男性（1·07 [0·99–1·15]）。男性与行为和心理社会风险因素相关的总 PAF (15·7%) 高于女性 (8·4%)，这主要是因为吸烟对男性 PAF 的贡献更大（即 1·3% [95女性的 % CI 0·5–2·1]而男性为10·7% [8·8–12·6]）。

解释

脂质标志物和抑郁症与男性心血管疾病风险的相关性高于女性，而饮食与女性心血管疾病风险的相关性高于男性。其他危险因素与女性和男性心血管疾病的相似关联强调了采取类似策略预防男性和女性心血管疾病的重要性。

资金

资金来源列于文章末尾。