Many CVD Risk Factors Remain Uncontrolled in Men and Women, but Emphasis Differs
Systolic BP and smoking have improved in both groups, but women have not made the same strides as men for BMI or total cholesterol control.
Despite public campaigns designed to raise awareness of heart disease risk factors in women, stark differences have persisted over the last few decades when it comes to how well certain risk factors are being managed in women as compared with men in the United States, new research shows.
“This suggests that current efforts haven’t been successful and that further efforts are particularly required to reduce the persistent sex differences in the control of hypertension, diabetes, and dyslipidemia,” wrote lead author Sanne Peters, PhD (The George Institute for Global Health, University of Oxford, England), in an email to TCTMD. “We know a lot about how these conditions should be managed, but there seems to be a persistent gap between what the evidence suggests and what happens in clinical practice.”
The paper appears this week as part of a special “Go Red for Women” edition of Circulation.
To assess gaps in changes in the prevalence and treatment of CVD risk factors in men and women over time, researchers drew on data from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2016. The study included 35,416 individuals ages 20 to 79; 51% were female.
BMI Climbed More Rapidly in Women, Cholesterol Fell More Slowly
In terms of overall trends, certain risk factors have been moving in the same direction for both men and women. For example, systolic blood pressure levels and smoking prevalence have declined, HDL cholesterol levels have stayed relatively stable, and the prevalence of diabetes has increased in both groups. For other risk factors, however, differences were more notable. Body mass index, for example, increased by 1.5 kg/m2 in women and by 1.1 kg/m2 in men between 2001-2004 and 2013-2016 (P = 0.006). Changes in total cholesterol, meanwhile, decreased from 201 to 188 mg/dL in men between the two time points, whereas the dip in women’s numbers was subtler, falling from 203 to 194 mg/dL.
Importantly, the prevalence of CVD risk factors across the entire study population was high. In 2013-2016, 60% of women had at least one CVD risk factor, and 9% of women presented with least three. For men, 69% of those studied had at least one CVD risk factor, with 10.4% having three or four.
And while the quality of risk factor management was “suboptimal in both sexes,” the emphasis appeared to be different between groups. “Men were less likely than women to have control of hypertension and diabetes, whereas women were less likely than men to have adequate control of dyslipidemia,” Peters et al write. Control rates for hypertension and diabetes in women both hovered around 30%, while men’s control rates were 22% and 20%, respectively. Inversely, men saw dyslipidemia control rates of 60%, whereas dyslipidemia control in women lagged at 51%.
These trends likely speak to the different ways in which men and women are screened and treated for CVD risk factors, noted Nisha Jhalani, MD (NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY), who commented on the study for TCTMD. “Either we’re not identifying the women that have higher cholesterol, or they are not tolerating treatment for it,” she said. “The same thing goes for blood pressure in men—either it’s just more aggressive and presents earlier in men or they’re not tolerating or taking their treatments.”
Earlier and More Consistent Screening Needed
The study results confirm what a lot of physicians already know, Jhalani noted, which is that even more effort needs to be placed in increasing awareness around CVD risk and providing treatment early on in adulthood. Screening for CVD risk factors as early as age 20 could help physicians identify unhealthy habits that could negatively impact health down the road, she said. “The way we eat, how much a person exercises, whether they are smoking—[these habits] are formed in early adulthood,” she said. As you get older, and your risk of heart disease increases, it can be harder to introduce healthy habits, such as daily exercise, she continued.
Screening young people is particularly important, since the study found the highest rates of smoking were in the youngest age group, age 20 to 35, noted Alexandra Lansky, MD (Yale University School of Medicine, New Haven, CT), who was not involved with the study. “More than 30% of this population is still smoking, so clearly trying to target the younger folks in the country and trying to impact the smoking rates in young patients I think is critical,” she said.
A focus on maintaining a healthy weight throughout our lifespans is also key, she added, since study data showed increased weight gain in women compared to men after age 50.
While the 15-year study did show a few positive trends, such as overall reduction in total cholesterol and smoking rates, Lansky emphasized that this study serves as a reminder that there is much more work to be done across the board in increasing awareness and treatment of CVD risk factors. “The take-home here is that we still have a long way to go,” she said.
Peters SAE, Muntner P, Woodward M. Sex differences in the prevalence of, and trends in, cardiovascular risk factors, treatment, and control in the United States, 2001-2016. Circulation. 2019;139:1025–1035.
- Peters, Jhalani, and Lansky report no relevant conflicts of interest.