Cardiovascular Risk Factors in Women: Vive la Différence

Do predictors of vascular disease differ between men and women?

In medicine, for far too long, men and women were lumped together into "one size fits all" algorithms or, worse, women were presumed to be smaller versions of their male counterparts. For example, variables considered to be cardiovascular risk factors in women largely remained the same for 40 years.¹ During this period, the science behind every aspect of heart disease-its etiology, prevention, and treatment-changed dramatically. Despite newly discovered lipid risk factors and novel markers of inflammation such as C-reactive protein, the predictive value of cardiovascular risk factors in women seemed oblivious to change... until recently.

A MARKER OF VASCULAR RISK IN WOMEN

The Reynolds Risk Score, verified specifically in women, has been validated as a predictor of their global cardiovascular risk.¹ Thirty-five potential risk factors were assessed in 24,558 women who were monitored for about 10 years for cardiovascular events. The result of the validated algorithm was that 50% of patients in this cohort were reclassified into higher- or lower-risk categories. The score includes high-sensitivity C-reactive protein (hs-CRP), among other markers. Although the algorithm itself may appear daunting at first glance, a more "user-friendly"¹ calculation may be accessed at www.reynoldsriskscore.org.

Elevated hs-CRP also correlates with the progression of early carotid vascular disease in women-but not in men.² The potential importance of this inflammatory marker in women was corroborated recently.³ Forty "initially healthy" women with baseline "very high" levels of hs-CRP were followed up for a median of 10 years. At baseline, the women with elevated hs-CRP levels had higher blood pressure, greater body mass index, lower high-density lipoprotein cholesterol levels, and higher triglyceride levels than women with lower levels of hs-CRP. In addition, women with elevated levels of hs-CRP had earlier myocardial infarctions (MIs) as well as more fatal MIs than women with lower levels. The Women's Health Study demonstrated that hs-CRP is associated with ischemic stroke in women.⁴

In summary, the progression of early carotid vascular disease, a tendency toward earlier and more frequently fatal MIs, and a higher risk of ischemic stroke all may be related to elevated hs-CRP levels in women.

FUTURE IMPLICATIONS FOR PRACTICE

These data are preliminary, especially when it comes to tailoring specific treatments based on gender. At least for now, prevention and treatment strategies in women, for the most part, will be similar to those in men. However, future work on the management of vascular disease will continue to capitalize on critical differences between men and women.

References:

REFERENCES:

1.

Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women.

JAMA

. 2007;297:611-619.

2.

Sander K, Horn C, Briesenick C, Sander D; INVADE Study Group. High-sensitivity C-reactive protein is independently associated with early carotid artery progression in women but not in men: the INVADE Study.

Stroke

. 2007;38:2881-2886.

3.

Bansal S, Ridker PM. Comparison of characteristics of future myocardial infarctions in women with baseline high versus baseline low levels of high-sensitivity C-reactive protein.

Am J Cardiol

. 2007;99:1500-1503.

4.

Everett BM, Kurth T, Buring JE, Ridker PM. The relative strength of C-reactive protein and lipid levels as determinants of ischemic stroke compared with coronary heart disease in women.

J Am Coll Cardiol

. 2006;48:2235-2242.