Coronary artery disease (CAD) is the leading cause of mortality worldwide. While it has been established that CAD-related mortality rates are significantly lower in women compared to men, sex differences in various risk factors and their impact on CAD outcomes have not been well quantified. In this prospective population-based study, 471,998 patients with no history of cardiovascular disease were followed for a mean of 7 years to investigate sex differences in risk factors for fatal and non-fatal myocardial infarction (MI). At baseline, there were fewer women than men with diabetes or atrial fibrillation. Amongst women, there were also and fewer patients on lipid lowering or blood pressure lowering drugs. In addition, women had slightly lower blood pressure and were less likely to have ever smoked than men at baseline. Researchers found that, after a mean follow-up of 7 years, 5,081 MI events occurred, 28.8% of which were in women. A multivariable model revealed that the rate of MI in women was less than half that in men (HR 0.37, 95% CI 0.35 to 0.40). Interestingly, women with elevated blood pressure were at a higher risk of MI than men with elevated blood pressure (ratio of hazard ratios 1.83, 95% CI 1.33 to 2.52). A similar pattern was seen with women who had ever smoked (ratio of hazard ratios 1.55, 95% CI 1.32 to 1.83). Women with diabetes (both type 1 and type 2) were also at a higher risk of MI than men with diabetes (ratio of hazard ratios 2.91 for type 1 diabetes, 95% CI 1.56 to 5.45; ratio of HRs 1.47 for type 2 diabetes, 95% CI 1.16 to 1.87). Results from this study therefore show that women with certain risk factors have an increased risk of MI as compared to men, specifically elevated blood pressure, smoking, and diabetes. These results further underline the importance of aggressively treating and addressing cardiovascular risk factors in women.
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