Comparison of the Sex-Specific Associations Between Systolic Blood Pressure and the Risk of Cardiovascular Disease

Abstract

In 2000, more than a quarter of the world's adult population, totaling nearly 1 billion people, were estimated to have hypertension-a figure that is projected to increase to 29% (1.5 billion) in 2025. 5 Worldwide, it is the leading risk factor for cardiovascular disease (CVD) and accounts for >13% (7 million) of deaths each year, as well as a substantial amount of disability. 1These estimates of disease burden are based on the assumption that the association between systolic blood pressure (SBP) and CVD does not appreciably differ between women and men. But this premise may not be wholly correct because results from previous large-scale pooling studies have been inconsistent. [6][7][8][9] Data from the Prospective Studies Collaboration (PSC), an individual participant data meta-analysis of 1 million individuals, showed slightly more extreme hazards for men compared with women for SBP-related stroke risk (particularly in younger age groups). 6 In contrast, in the Asia Pacific Cohort Studies Collaboration (APCSC), involving more than half a million individuals, no evidence of a sex difference at any age for the association between SBP and fatal stroke was found, 9 a finding that is in agreement with data from the extensive INTERSTROKE case-control study.7 For ischemic heart disease (IHD), results from the PSC showed slightly more extreme hazards associated with increases in SBP in women than in men (although no formal comparison was performed), particularly among younger age groups. 6 Similarly, a more extreme odds ratio for acute myocardial infarction associated with hypertension in women compared with men was reported in the INTERHEART case-control study. 8 In contrast, there was no sex difference with total IHD, fatal IHD, or nonfatal myocardial infarction in APCSC. 9 To date, there has been no systematic comparison of sex differences in the SBP-CVD relation. Given the possible implications that any sex difference might have on currentBackground and Purpose-Conflicting results have been reported on whether the association between increments in systolic blood pressure (SBP) and cardiovascular disease differs between men and women. We performed a systematic review with meta-analysis to compare reliably sex-specific associations between SBP and cardiovascular risk. Methods-PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between January 1, 1966, and March 31, 2012. Studies were selected if they presented sex-specific estimates, with associated variability, of the relative risk for either ischemic heart disease or stroke according to SBP. The data were pooled using random effects models with inverse variance weighting, and estimates of the ratio of the relative risks per 10 mm Hg increment in SBP, comparing women with men, were derived. Results-Data from 124 prospective cohort studies, including information on 1197 472 individuals (44% women) and 26 176 stroke and 24 434 ischemic heart disease events, were included. Overall, there was no evidence to suggest a sex ...

Total cholesterol as a risk factor for coronary heart disease and stroke in women compared with men: A systematic review and meta-analysis

“…Since women generally e at a given age e have a lower absolute risk for CVD, the same risk difference associated with a risk factor in each sex would translate into a higher relative effect in women. However, we have previously shown that the detection of a sex difference is neither inevitable [6,7,30], nor upon using relative risks to compare the sex-specific associations between risk factors and outcomes [2]. Thus, our current findings that the relative effects of high total cholesterol on CVD outcomes are largely similar between men and women are unlikely to be as a result of using relative rather than absolute measures of risk.…”

“…However, recent metaanalyses have reliably shown that there are clinically meaningful sex differences in the relationships between some risk factors and the risk of CHD and stroke, with stronger effects in women than in men for smoking and diabetes [2e5]. However, stronger excess relative risks in women are not inevitable: elevated levels of systolic blood pressure and body mass index were found to have equally deleterious effects on the risk of CHD and stroke in both sexes [6,7]. Whether a sex difference exists for the association between total cholesterol and CHD and stroke has never been systematically evaluated.…”

Cardiovascular Risk in Women With Premature Ovarian Insufficiency Compared to Premenopausal Women at Middle Age

“…Hypertension is a well-known major classical risk factor for the development of CVD. This was again emphasized in a recent meta-analysis including 1.2 million individuals, which reported a 15% increased risk of CHD and 25% increased risk of stroke in both men and women with every 10 mmHg increase in systolic BP, after adjustment for (sex-specific) confounders (47). Furthermore, a reduced glomerular filtration rate (GFR) is associated with an increased CVD risk in high risk populations such as patients with diabetes and hypertension (48).…”

Women-Specific Factors to Consider in Risk, Diagnosis and Treatment of Cardiovascular Disease

“…Also, hypertensive women had a lower risk of stroke and myocardial infarction than men but had a higher risk of developing heart failure with preserved ejection fraction [119]. However, Peters et al show that systolic blood pressure is not associated with higher risks of stroke or ischemic heart disease in one sex versus the other [124]. A review of randomized clinical trials by Turnbull et al concluded that differential hypertension treatment for men and women is unnecessary [125] because the efficacy of the various classes of pharmacological therapies (see ‘2014 Evidence-based Guidelines’ above) to prevent adverse cardiovascular events is similar in both populations [125].…”