Heartbeat: Ischemic heart disease risk factors in women
Cardiovascular disease is the leading cause of death in women worldwide. Despite the known sex differences in clinical presentation, management and outcomes of patients with coronary heart disease (CHD), possible differences in primary and secondary prevention have received less attention. In this issue of Heart, Zhao and colleagues 1 investigated sex differences in cardiovascular risk factor management in over 10 thousand patients (29% women) from Europe, Asia and the Middle East. Compared
... East. Compared with men, women had better blood pressure control and were more likely to be non-smokers. However, women were less likely to achieve medication targets for total cholesterol, low density lipoprotein cholesterol or serum glucose levels. In addition, women were more often obese and less physically active than men. Overall, lifestyle targets for cardiovascular risk reduction did not differ between women and men but women were about 25% less likely to achieve medication treatment targets with marked geographic sex disparities for both lifestyle and medication treatment targets (figure 1). In the accompanying editorial, Al Badri and colleagues 2 comment that "The failure to receive evidence-based therapies in women is sadly a recurrent theme increasingly documented worldwide". They conclude that: "Knowledge gaps remain, which can be addressed by careful phenotyping of the increasingly available digital medical records and ambulatory monitoring technology, including proteomics, metabolomics, and genomics. Investigation addressing if large sex differences in risk factor management are due to lower treatment of women/higher treatment of men (USA and Europe), vs if lower sex differences are due to lower treatment of both women and men (Asia and Middle East). The need for country and region-specific IHD data stratified by sex is needed to optimise personalised medicine" (figure 2). In a French study of 9012 men and women, age 50 to 75 years of age, Simon and colleagues 3 found that 14.77% of women but only 6.84% of men met at least 5 of the seven metrics defining ideal cardiovascular health. These metrics include ideal values for body mass index, smoking status, blood pressure, blood total cholesterol, blood glucose and physical activity. Women were slightly older, less educated, more often depressed and more deprived than men; after adjustment for these factors women were four times more often in ideal cardiovascular heart than men (OR 4.01, 95% CI 3.42 to 4.69). These findings parallel the findings in Europeans in the study by Zhao and colleagues 1 showing that risk factors Correspondence to Professor Figure 1 Age-adjusted sex differences on treatment targets and lifestyle factors management, stratified by region. Target blood pressure (BP) was defined as BP <140/90 mmHg in those without diabetes or <140/80 mmHg in those with diabetes. The target for total cholesterol (TC), low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol levels were defined as <3 mmol/L, <1.8 mmol/L, and >1.0 mmol/L for men and >1.2 mmol/L for women, respectively. Target glucose was defined as <7 mmol/L. Information on glycated haemoglobin (HbA1c) was only collected from patients with diabetes and its target was defined as <7%. *Achieving all three medical targets (BP on target, LDL on target, and glucose/HbA1c on target) was defined as 'All treatment targets'. Obesity was defined as a body mass index (BMI) ≥30 kg/ m2 and central obesity was defined as waist circumference ≥88 cm for women and ≥102 cm for men. Smoking status was current smoker and non-smoker. Adequate physical activity level was defined as moderate or vigorous physical activity for at least 30 min three or more times a week. *Reaching all three lifestyle targets (non-smoker, adequate physical activities, and nonobesity) was defined as 'All lifestyle targets'. Odds ratios (95% CI) presented as women versus men; p values are for interaction between subgroups. Figure 2 Sex-specific and gender-specific medicine is the most ready-for-translation approach among the genomic, proteomic, and metabolomic personalised medicine approaches. on 24 July 2018 by guest. Protected by copyright.