Women are less likely to develop heart diseases, especially at younger ages, because of a better risk profile compared to men, according to a recent study in The Lancet. It further established how patterns for risk factors and their association with people getting heart disease remained the same in low, middle, and high-income countries. The study was spread over 1.56 lakh people from 21 countries.

So, how many men and women developed heart diseases in the study?

Over the ten years that the 1.56 lakh participants were followed for, 4.7 per cent women and 7.6 per cent men had a major cardiovascular disease event. When standardised for age – the mean age of men was slightly higher than women participants – the researchers found that the incidence of cardiac events stood at 5 per 1,000 person-years in women and 8.2 per 1,000 person-years in men.

“Women have a more favourable cardiovascular risk profile than men, especially at younger ages. This finding was supported by lower rates of major cardiovascular disease in women than in men,” the study said.

This, the study said was not because the risk factors were very different in women but because they developed many of the risk factors – such as high cholesterol levels – later in life.

What are the risk factors in men and women?

When it came to the risk profile, the study found that the systolic blood pressure (pressure in the arteries when the heart is beating) increased with age in both men and women, but the mean levels tended to be lower in women. Similarly, fasting blood glucose levels increased with age in both sexes, but were slightly lower in women than in men until age 55–70 years.

Again, waist-to-hip ratio – which can give a more accurate measurement of belly fat than BMI – was found to be consistently lower in women than men across all age categories. A higher proportion of men were current or former smokers, consumed alcohol, and had low physical activity.

By contrast, the mean levels of non-HDL cholesterol or the bad cholesterols increased with age in women, but not in men. In fact, the concentration of all lipids increased in women with age, but a similar pattern was not seen in men. More women also reported symptoms of depression.

The risk factors associated with a major cardiovascular event were also slightly different in men and women — high non-HDL cholesterol was more strongly associated with major cardiovascular diseases in men than in women, whereas symptoms of depression were more strongly associated in men. Hypertension was the major risk of factor for cardiovascular disease in both women and men, followed by abdominal obesity in women and high non-HDL cholesterol in men.

“Women and men have similar risk factors, which emphasises the importance of a similar strategy for the prevention of cardiovascular diseases in men and women,” the paper’s first author and research fellow at the Population Health Research Institute (PHRI) of McMaster University Marjan Walli-Attaei said in a release.

However, diet was more strongly associated with risk in women than men – “something that’s not been previous described and which requires independent confirmation,” said Salim Yusuf, executive director of PHRI, professor of medicine at McMaster.

So, what needs to be done?

As the study shows , men have higher levels of metabolic risk factors at younger ages, hence the researchers suggest that the risk factor control should be initiated at an even younger age in men than in women.

The authors also suggested that studies were needed to see whether menopause could be an independent risk factor for heart diseases, because other studies that did follow pre- and post-menopausal women saw that the increase in bad cholesterol levels was more substantial than could be attributable to age. This was, however, not in the scope of the current study.

The researchers, referring to other studies, also said that use of statins can help in reducing bad cholesterol, thereby significantly reducing risk in men and women.

The researchers also said that smoking was a risk factor for men and women across the globe, and the difference in patterns of smoking reflected the difference in the levels of heart diseases and not an inherent reduced risk of smoking. “The well-established harmful effects of smoking highlight the importance of initiatives aimed at increasing smoking cessation rates and decreasing initiation rates in all smokers, irrespective of biological sex,” the study said.

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