More Evidence that Women Face Greater CVD Risk than Men, Even When Baseline Health is Equal
For the same level of baseline health, the increase in risk related to each of 8 key CV risk factors appears significantly higher in women than in men.
Women may be at greater risk for cardiovascular disease (CVD) than men from the same set of health and lifestyle factors associated with heart disease, according to new research. The study is the first to demonstrate that while women tend to have healthier lifestyles overall, those with negative risk factors experience a significantly steeper increase in CV risk compared to men with similar profiles, study authors said.
The findings, which will be presented in full during the American College of Cardiology Annual Scientific Sessions (ACC.25), March 29-31, add to the growing body of evidence that suggests sex-specific screening and risk assessment could give a more accurate picture of cardiovascular risk and the differences in that risk between men and women.
“For the same level of health, our study shows that the increase in risk [related to each factor] is higher in women than in men—it’s not one-size-fits-all,” Maneesh Sud, MD, PhD, assistant professor at Sunnybrook Health Sciences Centre and the study’s lead author, said in an ACC press statement. “This is novel and something that hasn’t been seen in other studies.”
Sud and colleagues analyzed data from more than 175,000 Canadian adults (60% women) enrolled in the Ontario Health Study (2009-2017), examining effects of 8 key CV risk factors: diet, sleep, physical activity, smoking, body mass index (BMI), blood glucose, lipids, and blood pressure. At baseline, none of the participants had evidence of CVD. Researchers categorized participants into 3 health profiles: ideal (meeting all 8 positive health markers), intermediate (5-7 positive factors), and poor (fewer than 5 positive or more than 3 negative factors). During a median follow-up of approximately 11 years, the research team tracked 7 outcomes: heart attack, stroke, unstable angina, peripheral arterial disease, heart failure, coronary revascularization, and cardiovascular death within each of the 3 health profile categories.
At baseline, Sud et al reported that more women than men were categorized as having ideal health, with 9.1% of women achieving a perfect score compared to just 4.8% of men. Likewise, fewer women (21.9%) were classified as having poor health than men (30.5%). Women had better scores for diet, blood glucose, cholesterol, and blood pressure, though they were slightly less likely than men to meet ideal physical activity levels.
In a model adjusted for participant age, both sexes were at elevated risk for CVD if they were categorized as having poor or intermediate health. However, despite their baseline advantages, the consequences of negative health markers were far more pronounced in women. Those with poor health had nearly 5 times the risk of heart disease as women with ideal health, whereas men with poor health had only 2.5 times the risk compared to their ideal-health counterparts. Similarly, women with intermediate health had 2.3 times the risk of CVD, while men in this category faced just 1.6 times the risk.
The findings highlight the need for sex-specific screening and risk assessment strategies, potentially leading to more personalized approaches in preventive cardiology. Further research is needed to determine whether biological or sociocultural factors drive these differences. The researchers also plan to explore variations across racial and ethnic groups and assess how menopause may influence cardiovascular risk.
