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Women are gaining ground on their male counterparts in their prevalence of acute myocardial infarction (AMI) as well as their risk factor scores.(1) Data from the National Health and Nutrition Examination Survey (NHANES) point to a cardiovascular risk burden that is worsening among women (35 to 54 years of age), while the risk burden among men is improving slightly. Historically, the conventional wisdom has been that this age group of women was protected from cardiovascular disease.
Towfighi and colleagues used the two phases of the multi-national NHANES study to examine changes in the gender-specific prevalence of AMI and the Framingham Coronary Risk Score (FCRS) among US adults — 35 to 54 years of age.
The first phase of NHANES was conducted from 1988 to 1994 and the second phase measured risk from 1994 to 2004. The researchers found that the prevalence of AMI decreased among men (from 2.5% to 2.2% for the period from Phase 1 to Phase 2, respectively). However, during the same measurement period, these AMI risk data increased from 0.7% to 1% among women. In addition, the ratio of men to women with a FCRS of 20% or greater declined from 32 to 18. While their AMI prevalence rates are lower than men’s, on a percentage basis, this report demonstrates that women may not be absolutely protected as once thought.
So what’s driving the increase in the risk burden and AMI rate?
One answer is that there seems to have been more improvements with the components of the FCRS among men. For example, only levels of high-density lipoprotein (HDL) cholesterol improved in women. Total cholesterol levels, systolic blood pressure, and the prevalence of tobacco smoking remained stable, whereas the presence of Type 2 diabetes mellitus (T2DM) and obesity worsened over time.
In contrast, men showed improvements in HDL cholesterol, blood pressure, and history of smoking. As was the case with women, men also showed higher rates of T2DM and obesity from the first survey period to the second time-point. Women’s risk factors were not as well-controlled as the cohort of men.
The Take-Home Messages for Clinicians: (A) We have to be more aggressive in identifying and treating cardiovascular risk factors in women, and (B) patient education and lifestyle counseling must be reinforced regarding adherence to medical regimens and controlling cardiovascular risk factors. We’ve all got to do a better job!
Reference
1. Towfigi A, Zheng L, Ovbiagele B. Sex-specific trends in midlife coronary heart disease risk and prevalence. Arch Intern Med 2009;169:1762-1766
Ken Korber is a PA in Chicago and the architect of the first PA postgraduate fellowship curriculum for cardiovascular care in the United States. He can be reached at his email address, kenneth.korber@gmail.com, for any comments or questions.
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