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


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.


BACKGROUND
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01164371.
From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.). j.george@ucl.ac.uk.
Julie
J
George
From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.).
Eleni
E
Rapsomaniki
From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.).
Mar
M
Pujades-Rodriguez
From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.).
Anoop Dinesh
AD
Shah
From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.).
Spiros
S
Denaxas
From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.).
Emily
E
Herrett
From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.).
Liam
L
Smeeth
From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.).
Adam
A
Timmis
From Farr Institute of Health Informatics Research (London), University College London, United Kingdom (J.G., M.P.-R., A.D.S., S.D., H.H.); Worldwide Clinical Trials, Nottingham, United Kingdom (E.R.); Farr Institute of Health Informatics Research (London), London School of Hygiene & Tropical Medicine, United Kingdom (E.H., L.S.); and Farr Institute of Health Informatics Research (London) and Barts National Institute for Health Research Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom (A.T.).
Harry
H
Hemingway
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002784:Cholesterol / Q000097:blood; D003278:Contraceptives, Oral, Hormonal; D003920:Diabetes Mellitus / Q000453:epidemiology; D057286:Electronic Health Records; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology
D000959:Antihypertensive Agents; D003278:Contraceptives, Oral, Hormonal; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol
aging; cardiovascular diseases; electronic health records; incidence; population; risk factors; sex