BP elevations occurred more rapidly in women compared with men and as early as the third decade of life, which may explain why CVD presents at different times between both sexes, according to a study published in JAMA Cardiology.
“Many of us in medicine have long believed that women simply ‘catch up’ to men in terms of their cardiovascular risk,” Cardiology Today Editorial Board Member Susan Cheng, MD, MPH, MMSc, director of public health research at the Smidt Heart Institute, director of cardiovascular population sciences at the Barbra Streisand Women’s Heart Center and the Erika J. Glazer Chair in Women’s Cardiovascular Health at Cedars-Sinai, said in a press release. “Our research not only confirms that women have different biology and physiology than their male counterparts, but also illustrates why it is that women may be more susceptible to developing certain types of cardiovascular disease and at different points in life.”
Data from community cohorts
Hongwei Ji, MD, of the division of cardiology at Brigham and Women’s Hospital and Harvard Medical School, and colleagues analyzed from 32,833 participants (54% female) aged 5 to 98 years from four community cohorts: Framingham Heart Study offspring cohort, the CARDIA study, the ARIC study and MESA.
Data including BP measures were collected from 144,599 observations from 1971 to 2014. BP trajectories were estimated with mixed-effects regression models for women and men with age as a common timescale.
New-onset hard CVD events occurred in 24.8% of participants over 4 decades.
Compared with men, women exhibited a faster rate of BP elevation with aging, which was present as early as the third decade of life (likelihood ratio chi-square test = 531 for systolic BP; chi-square test = 123 for diastolic BP; chi-square test = 325 for mean arterial pressure; chi-square test = 572 for pulse pressure; P for all < .001).
Differences between both sexes persisted after adjusting for clinical covariates including total cholesterol, BMI, current smoking and diabetes life (likelihood ratio chi-square test = 314 for systolic BP; chi-square test = 31 for diastolic BP; chi-square test = 129 for mean arterial pressure; chi-square test = 485 for pulse pressure; P for all < .001).
“In effect, sex differences in physiology, starting in early life, may well set the stage for later-life cardiac as well as vascular diseases that often present differently in women compared with men,” Ji and colleagues wrote. “Additional work is needed to further understand sexual dimorphism in cardiovascular risk to optimize prevention and management efforts in both women and men.”
Women in research
Nanette K. Wenger
In a related editorial, Cardiology Today Editorial Board Member Nanette K. Wenger, MD, MACC, MACP, professor of medicine (cardiology) at Emory University School of Medicine, consultant at Emory Heart and Vascular Center, wrote: “We must remember that the cardiovascular health of women involves more than sex-specific medical research. The emerging science will be useful only when women have equal access to high-quality, affordable health care. Women’s equity thus involves equity in research and prevention and equal access to care and treatments.” – by Darlene Dobkowski
Disclosures: Cheng reports she received grants from the NIH and personal fees from Zogenix. Ji and Wenger report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.