The female advantage in cardiovascular disease: Do vascular beds contribute equally?

Abstract

Conclusion: There is a larger gender difference in atherosclerosis of the coronary vessels than in other vascular beds, with women having less severe disease than men. There are no gender differences in the aorta and lower extremity vessels. Summary: It is widely acknowledged that women have less incidence of coronary heart disease than men. In this study, the authors sought to characterize gender differences in cardiovascular disease according to vascular site. Degrees of coronary, carotid, peripheral, and aortic atherosclerosis were compared in men and women aged >55 years from the population-based Rotterdam Study. The study used data collected between 1997 and 2000. This report involved a subset of 2013 participants in the Rotterdam Study who had data on both coronary calcification and at least one other measure of noncoronary atherosclerosis. These measures included intimal medial thickness (IMT), ankle-brachial index (ABI), carotid plaque, and aortic calcification. The male/female multivariable-adjusted odds ratio for calcium score >1000 in the lowest, middle, and highest age tertiles were 7.8 (95% confidence interval [CI], 3.2-19.3), 5.4 (95% CI, 2.8-10.2), and 3.0 (95% CI, 1.7-5.2), respectively. There was no decline in ratios with age for IMT >1.0 mm, severe carotid plaques, ABI <0.9, and the presence of severe aortic calcification. The male/female multivariable-adjusted odds ratios for these measures were 2.9 (95% CI, 2.0-4.1), 2.0 (95% CI, 1.4-2.8), 0.9 (95% CI, 0.7-1.3), and 1.0 (95% CI, 0.8-1.5), respectively. Comment: Present knowledge does not explain the gender differences in cardiovascular disease in the different vascular beds. Subanalysis presented in the article indicates the gender ratios between sites are not explained by differences in traditional cardiovascular disease risk factors. There must be either unknown gender-specific risk factors for cardiovascular disease or gender-specific responses to known cardiovascular risk factors.