心血管疾病初始表现男女有别

BMJ 杂志11月17日发表了一篇以人群为基础的前瞻性队列研究，作者比较了8419位荷兰男女的心血管疾病初始表现。经过长达20.1年的随访发现在对55岁的男性和女性的终生心血管疾病事件风险是相似的。每千人中，女性终身心血管事件和男性的数差为-7，冠心病-102，脑血管+70，心衰+26，其它心血管死亡因素-1；女性群体发生上述事件的年龄均高于男性。

虽然男性和女性面临的终生心血管疾病风险相当，但初始事件存在很大差异。男性最常见初始事件是冠心病，女性则多为脑血管疾病或心力衰竭，且事件发生时年龄较大死亡率更高。

专家评述

埃默里大学医学院Nanette K Wenger MD教授

来自鹿特丹8419名＞55岁参与者的以人群为基础的前瞻性队列研究数据表明，男性和女性面临的终生心血管疾病风险和初始事件存在差异。尽管男性和女性面临的终生心血管疾病风险相当，但初始心血管疾病事件不同。女性往往以脑血管疾病和心衰为初始事件，与此相反，男性则多以冠心病为初始事件。尽管女性的终生心血管疾病风险要略低于男性(38.1% vs 43.2%)，非侵入性治疗的心绞痛，由于被认为病情较轻，没有统计在心血管疾病之内。女性常以心绞痛作为心血管疾病的初始事件，如果将其考虑进来，将消除终生心血管疾病风险的性别差异。虽然如此，心绞痛增加了心血管疾病的临床和经济负担。欧洲人使用SCORE算法来评估心血管风险，而美国心脏病学会/美国心脏协会指南主张使用性别特异性汇集队列方程。尽管如此，两者皆可以开展针对性的个体化生活方式和药物干预措施，以减少全球动脉粥样硬化性心血管疾病的负担。

 

TAKE-HOME MESSAGE

The authors of this prospective, population-based, cohort study compared first manifestations of cardiovascular disease among 8419 Dutch men and women. After up to 20.1 years of follow-up, overall lifetime risks for cardiovascular disease were similar in men and women at age 55. Per 1000 patients, women experienced −7 events for any cardiovascular disease, −102 events for coronary heart disease, 70 events for cerebrovascular disease, 26 events for heart failure, and −1 event for other cardiovascular death over the course of a lifetime compared with men. All of these outcomes occurred later in women than men.

While both men and women have comparable lifetime risks of cardiovascular disease, first manifestation differs between sexes. In men, the first event is likely to be coronary heart disease, but women are more likely to develop cerebrovascular disease or heart failure.

Expert Comment

Data from the 8419 participants in the Rotterdam Study delineate the sex differences in the lifetime risk and the initial manifestations of cardiovascular disease in a prospective population-based cohort >55 years of age. Although the risk of developing cardiovascular disease over their lifetimes was similar for women and for men, the initial manifestations of cardiovascular disease differed. Women more often had cerebrovascular disease or heart failure as their initial presentation, in contrast to coronary heart disease for men. Although the lifetime risk for cardiovascular disease was lower for women than for men (38.1% vs 43.2%), non-invasively managed angina pectoris, judged to constitute a soft coronary event, was not included as an outcome. Angina as the initial manifestation of coronary heart disease is more prominent in women, and its inclusion likely would have diminished the absolute coronary heart disease risk difference between the sexes. However, angina contributes both to the clinical and the economic burden of cardiovascular disease. Europeans employ the SCORE algorithm for the estimation of cardiovascular risk, whereas the American College of Cardiology/American Heart Association guidelines advocate use of the Pooled Cohort Equations (which are gender-specific); nonetheless, both enable identification of individuals warranting targeted lifestyle and pharmacologic interventions to lessen the global burden of atherosclerotic cardiovascular disease.

BMJ : British Medical Journal

Sex Differences in Lifetime Risk and First Manifestation of Cardiovascular Disease: Prospective Population Based Cohort Study

BMJ 2014 Nov 17;349(xx)g5992, MJ Leening, BS Ferket, EW Steyerberg, M Kavousi, JW Deckers, D Nieboer, J Heeringa, ML Portegies, A Hofman, MA Ikram, MG Hunink, OH Franco, BH Stricker, JC Witteman, JW Roos-Hesselink

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

This abstract is available on the publisher's site.

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