title: Sex differences in cardiovascular risk factors and disease prevention.
abstract: Cardiovascular disease (CVD) has been seen as a men's disease for decades, however it is more common in women than in men. It is generally assumed in medicine that the effects of the major risk factors (RF) on CVD outcomes are the same in women as in men. Recent evidence has emerged that recognizes new, potentially independent, CVD RF exclusive to women. In particular, common disorders of pregnancy, such as gestational hypertension and diabetes, as well as frequently occurring endocrine disorders in women of reproductive age (e.g. polycystic ovary syndrome (PCOS) and early menopause) are associated with accelerated development of CVD and impaired CVD-free survival. With the recent availability of prospective studies comprising men and women, the equivalency of major RF prevalence and effects on CVD between men and women can be examined. Furthermore, female-specific RFs might be identified enabling early detection of apparently healthy women with a high lifetime risk of CVD. Therefore, we examined the available literature regarding the prevalence and effects of the traditional major RFs for CVD in men and women. This included large prospective cohort studies, cross-sectional studies and registries, as randomised trials are lacking. Furthermore, a literature search was performed to examine the impact of female-specific RFs on the traditional RFs and the occurrence of CVD. We found that the effects of elevated blood pressure, overweight and obesity, and elevated cholesterol on CVD outcomes are largely similar between women and men, however prolonged smoking is significantly more hazardous for women than for men. With respect to female-specific RF only associations (and no absolute risk data) could be found between preeclampsia, gestational diabetes and menopause onset with the occurrence of CVD. This review shows that CVD is the main cause of death in men and women, however the prevalence is higher in women. Determination of the CV risk profile should take into account that there are differences in impact of major CV RF leading to a worse outcome in women. Lifestyle interventions and awareness in women needs more consideration. Furthermore, there is accumulating evidence that female-specific RF are of influence on the impact of major RF and on the onset of CVD. Attention for female specific RF may enable early detection and intervention in apparently healthy women. Studies are needed on how to implement the added RF's in current risk assessment and management strategies to maximize benefit and cost-effectiveness specific in women.
authors: Department of Cardiology, VU University Medical Center, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: y.appelman@vumc.nl.
authors: Yolande
authors: Y
authors: Appelman
authors: Department of Obstetrics, Division Woman and Baby, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Academic Unit of Human Development and Health, Princess Anne Hospital, University of Southampton, Coxford Rd, Southampton, Hampshire SO16 5YA, United Kingdom. Electronic address: B.Van-Rijn@soton.ac.uk.
authors: Bas B
authors: BB
authors: van Rijn
authors: Department of Cardiology, VU University Medical Center, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: m.tenhaaf@vumc.nl.
authors: Monique E
authors: ME
authors: Ten Haaf
authors: Thoraxcenter Cardiology, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. Electronic address: h.boersma@erasmusmc.nl.
authors: Eric
authors: E
authors: Boersma
authors: The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, United Kingdom; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands. Electronic address: S.A.E.Peters@umcutrecht.nl.
authors: Sanne A E
authors: SA
authors: Peters
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008019:Life Style; D008297:Male; D010641:Phenotype; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome
keywords: Atherosclerosis; Cardiovascular disease; Gender; Prevention; Risk factors; Sex-differences