Abstract
BackgroundAlthough men are more prone to developing cardiovascular disease (CVD) than women, risk factors for CVD, such as nicotine abuse and diabetes mellitus, have been shown to be more detrimental in women than in men.ObjectiveWe developed a method to systematically investigate population-wide electronic health records for all possible associations between risk factors for CVD and other diagnoses. The developed structured approach allows an exploratory and comprehensive screening of all possible comorbidities of CVD, which are more connected to CVD in either men or women.MethodsBased on a population-wide medical claims dataset comprising 44 million records of inpatient stays in Austria from 2003 to 2014, we determined comorbidities of acute myocardial infarction (AMI; International Classification of Diseases, Tenth Revision [ICD-10] code I21) and chronic ischemic heart disease (CHD; ICD-10 code I25) with a significantly different prevalence in men and women. We introduced a measure of sex difference as a measure of differences in logarithmic odds ratios (ORs) between male and female patients in units of pooled standard errors.ResultsExcept for lipid metabolism disorders (OR for females [ORf]=6.68, 95% confidence interval [CI]=6.57-6.79, OR for males [ORm]=8.31, 95% CI=8.21-8.41), all identified comorbidities were more likely to be associated with AMI and CHD in females than in males: nicotine dependence (ORf=6.16, 95% CI=5.96-6.36, ORm=4.43, 95% CI=4.35-4.5), diabetes mellitus (ORf=3.52, 95% CI=3.45-3.59, ORm=3.13, 95% CI=3.07-3.19), obesity (ORf=3.64, 95% CI=3.56-3.72, ORm=3.33, 95% CI=3.27-3.39), renal disorders (ORf=4.27, 95% CI=4.11-4.44, ORm=3.74, 95% CI=3.67-3.81), asthma (ORf=2.09, 95% CI=1.96-2.23, ORm=1.59, 95% CI=1.5-1.68), and COPD (ORf=2.09, 95% CI 1.96-2.23, ORm=1.59, 95% CI 1.5-1.68). Similar results could be observed for AMI.ConclusionsAlthough AMI and CHD are more prevalent in men, women appear to be more affected by certain comorbidities of AMI and CHD in their risk for developing CVD.
Highlights
Despite the overall higher prevalence of cardiovascular disease (CVD) in men, the gender gap in CVD narrows with age, especially postmenopause [1]
To clarify the role of comorbidities in the CVD gender gap, we aimed at developing a structured approach to screening and identifying sex-specific differences in comorbidities associated with CVD in this analysis
The female sex has independently been associated with chronic kidney disease (CKD) among ST-elevation myocardial infarction (STEMI) patients, which resulted in a 2-fold relative increase of in-hospital mortality for women in the same study [9]
Summary
Despite the overall higher prevalence of cardiovascular disease (CVD) in men, the gender gap in CVD narrows with age, especially postmenopause [1]. Potential explanations are plentiful and range from a menopausal drop in protective estrogen to certain comorbidities affecting women in a more impactful way [2,3,4,5] Whether these findings just represent anecdotal evidence or whether they hint at a systematic development in which, given certain risk factors, women are getting an increasingly higher risk for CVD than men is currently unclear. The female sex has independently been associated with CKD among ST-elevation myocardial infarction (STEMI) patients, which resulted in a 2-fold relative increase of in-hospital mortality for women in the same study [9]. Men are more prone to developing cardiovascular disease (CVD) than women, risk factors for CVD, such as nicotine abuse and diabetes mellitus, have been shown to be more detrimental in women than in men
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