Sex differences in lifetime risk and first manifestation of cardiovascular disease: prospective population based cohort study.
OBJECTIVE
To evaluate differences in first manifestations of cardiovascular disease between men and women in a competing risks framework.


METHODS
Prospective population based cohort study.


METHODS
People living in the community in Rotterdam, the Netherlands.


METHODS
8419 participants (60.9% women) aged ≥ 55 and free from cardiovascular disease at baseline.


METHODS
First diagnosis of coronary heart disease (myocardial infarction, revascularisation, and coronary death), cerebrovascular disease (stroke, transient ischaemic attack, and carotid revascularisation), heart failure, or other cardiovascular death; or death from non-cardiovascular causes. Data were used to calculate lifetime risks of cardiovascular disease and its first incident manifestations adjusted for competing non-cardiovascular death.


RESULTS
During follow-up of up to 20.1 years, 2888 participants developed cardiovascular disease (826 coronary heart disease, 1198 cerebrovascular disease, 762 heart failure, and 102 other cardiovascular death). At age 55, overall lifetime risks of cardiovascular disease were 67.1% (95% confidence interval 64.7% to 69.5%) for men and 66.4% (64.2% to 68.7%) for women. Lifetime risks of first incident manifestations of cardiovascular disease in men were 27.2% (24.1% to 30.3%) for coronary heart disease, 22.8% (20.4% to 25.1%) for cerebrovascular disease, 14.9% (13.3% to 16.6%) for heart failure, and 2.3% (1.6% to 2.9%) for other deaths from cardiovascular disease. For women the figures were 16.9% (13.5% to 20.4%), 29.8% (27.7% to 31.9%), 17.5% (15.9% to 19.2%), and 2.1% (1.6% to 2.7%), respectively. Differences in the number of events that developed over the lifespan in women compared with men (per 1000) were -7 for any cardiovascular disease, -102 for coronary heart disease, 70 for cerebrovascular disease, 26 for heart failure, and -1 for other cardiovascular death; all outcomes manifested at a higher age in women. Patterns were similar when analyses were restricted to hard atherosclerotic cardiovascular disease outcomes, but absolute risk differences between men and women were attenuated for both coronary heart disease and stroke.


CONCLUSIONS
At age 55, though men and women have similar lifetime risks of cardiovascular disease, there are considerable differences in the first manifestation. Men are more likely to develop coronary heart disease as a first event, while women are more likely to have cerebrovascular disease or heart failure as their first event, although these manifestations appear most often at older ages.
Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Epidemiology, Harvard School of Public Health, Boston, MA, US.
Maarten J G
MJ
Leening
Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Radiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Institute of Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, US.
Bart S
BS
Ferket
Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
Ewout W
EW
Steyerberg
Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
Maryam
M
Kavousi
Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
Jaap W
JW
Deckers
Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
Daan
D
Nieboer
Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
Jan
J
Heeringa
Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
Marileen L P
ML
Portegies
Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Epidemiology, Harvard School of Public Health, Boston, MA, US.
Albert
A
Hofman
Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Radiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
M Arfan
MA
Ikram
Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Radiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, US.
M G Myriam
MG
Hunink
Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
Oscar H
OH
Franco
Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Inspectorate for Health Care, The Hague, Netherlands b.stricker@erasmusmc.nl.
Bruno H
BH
Stricker
Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
Jacqueline C M
JC
Witteman
Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
Jolien W
JW
Roos-Hesselink
D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology; D003327:Coronary Disease / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D012044:Regression Analysis; D012737:Sex Factors