Prospective analysis of gender-related characteristics in relation to cardiovascular disease

Abstract

Abstract Background Cardiovascular diseases (CVD) are a major public health problem in men and women worldwide. Differences in CVD incidence between men and women have been widely reported, although explanations for these differences remain unclear. Next to sex-related (biological) characteristics, gender-related (sociocultural) characteristics may partly explain how these differences arise. We aimed to establish the associations between selected gender-related characteristics and CVD incidence. Methods We linked baseline data of 18,058 participants without CVD from the population-based, multi-ethnic HELIUS study (Amsterdam, the Netherlands) to CVD incidence data, based on hospital admission and death records from Statistics Netherlands in 2013-2018. Using Cox regression analyses, we studied associations of time spent on household work, doing home repairs, primary earner status, type of employment, performing a male-dominated or female-dominated occupation, and desire for emotional support with CVD incidence, overall (with or without adjustment for sex) and stratified by sex. Analyses were adjusted for age, ethnicity, and socioeconomic status. Results In the fully adjusted analyses, most gender-related characteristics were not associated with higher CVD incidence, overall and among men. In women, homemakers had a higher hazard for CVD compared to fulltime workers (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.35-4.04), whereas those spending a moderate amount of time on household work had a lower hazard for CVD than those spending little time (HR 0.56, 95% CI 0.34-0.95). Conclusions Although most gender-related characteristics were not associated with CVD incidence in men, being the homemaker and time spent on household work were associated with CVD incidence in women. Thus, attention to gender-related characteristics may in future help to identify subgroups that may benefit from additional prevention strategies. Key messages Some gender-related characteristics are relevant for cardiovascular disease risk, particularly in women. Attention to gender-related characteristics may in future help to identify subgroups that may benefit from additional prevention strategies.