Recent findings being presented at the American College of Cardiology’s Annual Scientific Session support the concept that there is no one-size-fits-all approach to health screenings and risk assessments among men and women; indicating that both lifestyle and health factors that are linked with heart disease appear to have a greater impact on the cardiovascular risks in women than they do in men.
Exercise, diet, blood pressure, and history of smoking are lifestyle factors that have been linked with the risk of heart disease; however, this is the first study to show these associations are collectively stronger among women. The researchers believe that the findings indicate that sex-specific health screenings or risk assessment approaches could provide a more accurate picture of cardiovascular risk and help motivate people more to adopt heart-friendly lifestyle habits.
“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,” said Maneesh Sud, MD, PhD, assistant professor in the department of medicine, interventional cardiologist and clinician scientist at Sunnybrook Health Sciences Centre in Toronto and the study’s lead author. “This is novel and something that hasn’t been seen in other studies.”
Investigating lifestyle risks
This study analyzed data from over 175,000 adults without heart disease at baseline with a median follow-up period of over 11 years. Focusing on 8 lifestyle factors that are associated with heart disease: physical activity, sleep, history of smoking, lipids and blood pressure, diet, blood glucose levels, and body mass index, participants were classified as being in ideal or poor health in each of the 8 lifestyle risk factors, and scores were combined to calculate an overall risk factor as poor with fewer the 5 positive factors or more than 3 negative factors; intermediate with 5 to 7 positive factors; or ideal across all 8 lifestyle factors.
Researchers tracked the incidence of 7 heart disease outcomes: unstable angina, heart attack, stroke, heart failure, peripheral arterial disease, coronary revascularization, and cardiovascular death in each of the three groups. The results showed that women are more likely to have fewer negative risk factors and more positive ones. However, women with more negative risk factors were found to have a more pronounced increase in their risk of stroke, heart attack, or other cardiovascular events compared to men with similar risk factor profiles.
“We found that women tend to have better health than men, but the impact on outcomes is different,” Sud said. “The combination of these factors has a bigger impact in women than it does in men.”
The analysis revealed that significantly more women were categorized as having ideal health, with 9.1% of women and 4.8% of men scoring 8 out of 8, while 21.9% of women and 30.5% of men were scored as having poor health. The analysis also revealed that in terms of individual risk factors, women were more likely to have an ideal diet, and blood glucose levels, as well as cholesterol and blood pressure levels, compared to men, even though women were found to be slightly less likely to have ideal physical activity levels than men.
Heavier on a woman’s heart
Even after adjusting for age and various factors, the results showed that participants of both sexes experienced an increased risk of heart disease if they had poor or intermediate scoring compared to those with ideal health, and these differences were more extreme among women. Women with poor health were found to have close to five times the risk of heart disease as those with ideal health, while men with poor health had 2.5 times the risk of heart disease compared to men with ideal health. Women with intermediate health had 2.3 times the risk, and men with intermediate health had 1.6 times the risk as those with ideal health.
The researchers noted that further investigation is needed to understand how each factor might be affecting the outcomes differently among the sexes. The team plans to conduct additional analyses to investigate whether there are any differences in risk factor impact among those of different ethnic and racial groups, as well as among women before and after menopause.
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