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

George, J. Rapsomaniki, E. Pujades-Rodriguez, M. Shah, A.D. Denaxas, S. Herrett, E. Smeeth, L. Timmis, A. Hemingway, H.
Circulation, 2015;132(14):1320-8.

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 (CVD). We compared the incidence of 12 cardiac, cerebrovascular, and peripheral vascular diseases in women and men at different ages.

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 (CALIBER research platform). During 6 years median follow-up between 1997-2010, 114,859 people experienced an incident cardiovascular diagnosis, the majority (66%) of which were neither myocardial infarction (MI) nor ischemic stroke. Associations of male sex with initial diagnoses of CVD, however, varied from strong (age-adjusted hazard ratios (HR) 3.6-5.0) for abdominal aortic aneurysm, MI and unheralded coronary death (particularly under 60 years), through modest (HR 1.5-2.0) for stable angina, ischemic stroke, peripheral arterial disease, heart failure and cardiac arrest, to weak (HR <1.5) for transient ischemic attack, intracerebral hemorrhage and unstable angina, and inverse (0.69) for sub-arachnoid hemorrhage (all p<0.001).

The majority of initial presentations of CVD are neither MI 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. Clinical Trial Registration Information-www.clinicaltrials.gov. Identifier: NCT01164371.