Do sex differences in the prevalence of ECG abnormalities vary across ethnic groups living in the Netherlands? A cross-sectional analysis of the population-based HELIUS study

Abstract

ObjectivesMajor ECG abnormalities have been associated with increased risk of cardiovascular disease (CVD) burden in asymptomatic populations. However, sex differences in occurrence of major ECG abnormalities have been poorly studied, particularly across ethnic groups. The objectives were to investigate (1) sex differences in the prevalence of major and, as a secondary outcome, minor ECG abnormalities, (2) whether patterns of sex differences varied across ethnic groups, by age and (3) to what extent conventional cardiovascular risk factors contributed to observed sex differences.DesignCross-sectional analysis of population-based study.SettingMulti-ethnic, population-based Healthy Life in an Urban Setting cohort, Amsterdam, the Netherlands.Participants8089 men and 11 369 women of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin aged 18–70 years without CVD.Outcome measuresAge-adjusted and multivariable logistic regression analyses were performed to study sex differences in prevalence of major and, as secondary outcome, minor ECG abnormalities in the overall population, across ethnic groups and by age-groups (18–35, 36–50 and >50 years).ResultsMajor and minor ECG abnormalities were less prevalent in women than men (4.6% vs 6.6% and 23.8% vs 39.8%, respectively). After adjustment for conventional risk factors, sex differences in major abnormalities were smaller in ethnic minority groups (OR ranged from 0.61 in Moroccans to 1.32 in South-Asian Surinamese) than in the Dutch (OR 0.49; 95% CI 0.36 to 0.65). Only in South-Asian Surinamese, women did not have a lower odds than men (OR 1.32; 95% CI 0.96 to 1.84). The pattern of smaller sex differences in ethnic minority groups was more pronounced in older than in younger age-groups.ConclusionsThe prevalence of major ECG abnormalities was lower in women than men. However, sex differences were less apparent in ethnic minority groups. Conventional risk factors did not contribute substantially to observed sex differences.

Sex differences in incidence of out-of-hospital cardiac arrest across ethnic and socioeconomic groups: A population-based cohort study in the Netherlands

“…In contrast to previous limited evidence on other CVD outcomes [10,11], we observed that sex differences in OHCA incidence are consistent across most ethnic groups, independently of SES. Only in the Moroccan group, the OHCA incidence is more similar between men and women, which is mainly due to the lower OHCA incidence among Moroccan men compared to other men.…”

“…The incidence of OHCA in men and women may differ across subgroups within the population, such as ethnic or socioeconomic (SES) groups. For instance, studies on other relevant cardiovascular disease (CVD) outcomes (e.g., coronary heart disease mortality [10] and major electrocardiographic abnormalities [11]) suggest that sex differences in occurrence of CVD outcomes may be smaller in ethnic minority groups compared to the majority population (in high-income countries), independently of established CVD risk factors. The explanations remain unclear, but may be related to modifying effects of less conventional and potentially overlooked risk factors, such as psychosocial factors (e.g., discrimination) [12].…”

Sex differences in patterns of referral and resource utilization in the cardiology clinic: an outpatient analysis

“…ECG abnormalities were the main reason for consultation in men at all ages. The higher incidence of ECG abnormalities in men compared with women has been described previously ( 37 , 38 ), and may be partly explained by the higher incidence of cardiovascular disease in men, particularly ischaemic heart disease, which occurs at a younger age ( 39 ). The reason for the higher referral rate may be that general practitioners may be more concerned about the presence of structural heart disease in men with ECG abnormalities.…”

Prevalence and factors associated with electrocardiographic abnormalities among adults attending Methadone Assisted Therapy in Dodoma, central Tanzania

“…Our study showed that being male had a positive association with ECG abnormalities. Generally, males are observed to have higher cardiovascular risk at a relatively younger age (37) compared to female counterparts exposed to cardioprotective endogenous estrogen during the fertile period. However, the benefit is lost post-menopausal (38).…”