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Review
. 2024 May;13(2):97-110.
doi: 10.12997/jla.2024.13.2.97. Epub 2024 Jan 16.

Differences in Risk Factors for Coronary Atherosclerosis According to Sex

Hack-Lyoung Kim  1
Affiliations
Review

Differences in Risk Factors for Coronary Atherosclerosis According to Sex

Hack-Lyoung Kim. J Lipid Atheroscler. 2024 May.

Abstract

Interest in sex differences related to coronary artery disease (CAD) has steadily increased, and the risk factors for CAD show distinct sex differences. For women, cardiovascular risk increases significantly after menopause due to a decrease in estrogen levels. In older individuals, increased arterial stiffness results in a higher pulse pressure, leading to a more common occurrence of isolated systolic hypertension; these changes are more noticeable in women. While the incidence of diabetes is similar in both sexes, women with diabetes face a 50% higher relative risk of fatal coronary heart disease compared to men. Smoking significantly increases the risk of ischemic heart disease in women, particularly those who are younger. The decrease in estrogen in women leads to a redistribution of fat, resulting in increased abdominal obesity and, consequently, an elevated cardiovascular risk. Pregnancy and reproductive factors also have a significant impact on CAD risks in women. Additionally, disparities exist in medical practice. Women are less likely to be prescribed cardioprotective drugs, referred for interventional or surgical treatments, or included in clinical research than men. By increasing awareness of these sex differences and addressing the disparities, we can progress toward more personalized treatment strategies, ultimately improving patient outcomes.

Keywords: Atherosclerosis; Cardiovascular disease; Gender; Heart disease risk factors; Sex.

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Conflict of interest statement

Conflict of Interest: The author has no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1. Cardiovascular protective effects of estrogen.
Fig. 2
Fig. 2. Mechanisms of how cardiovascular risk increases in postmenopausal women.
Fig. 3
Fig. 3. Cardiovascular risk factors in women.
LV, left ventricular; PCOS, polycystic ovary syndrome; PIH, pregnancy induced hypertension.
See this image and copyright information in PMC

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References

    1. Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, et al. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation. 2023;147:e93–ee621. - PubMed
    1. GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1736–1788. - PMC - PubMed
    1. Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J., 3rd Factors of risk in the development of coronary heart disease--six year follow-up experience. The Framingham Study. Ann Intern Med. 1961;55:33–50. - PubMed
    1. Reissigová J, Tomecková M. State of the art coronary heart disease risk estimations based on the Framingham Heart Study. Cent Eur J Public Health. 2005;13:180–186. - PubMed
    1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–1913. - PubMed