(Circulation. 1999;99:1165-1172.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Sex, Age, Cardiovascular Risk Factors, and Coronary Heart Disease
A Prospective Follow-Up Study of 14 786 Middle-Aged Men and Women in Finland
From the National Public Health Institute, Department of Epidemiology and Health Promotion, Helsinki, Finland.
Background—Coronary heart disease (CHD) is markedly more common in men than in women. In both sexes, CHD risk increases with age, but the increase is sharper in women. We analyzed the extent to which major cardiovascular risk factors can explain the sex difference and the age-related increase in CHD risk.
Methods and Results—The study cohort consists of 14 786 Finnish
men and women 25 to 64 years old at baseline. The following
cardiovascular risk factors were determined: smoking,
serum total cholesterol, HDL cholesterol, blood
pressure, body mass index, and diabetes. Risk factor measurements were
done in 1982 or 1987, and the cohorts were followed up until the end of
1994. The Cox proportional hazards model was used to assess the
relation between risk factors and CHD risk. CHD incidence in men
compared with women was 
3 times higher and mortality was 5 times
higher. Most of the risk factors were more favorable in women, but the
sex difference in risk factor levels diminished with increasing age.
Differences in risk factors between sexes, particularly in HDL
cholesterol and smoking, explained nearly half of the
difference in CHD risk between men and women. Differences in serum
total cholesterol level, blood pressure, body mass index,
and diabetes prevalence explained about one-third of the
age-related increase in CHD risk among men and 50% to 60% among
women.
Conclusions—Differences in major cardiovascular risk factors explained a substantial part of the sex difference in CHD risk. An increase in risk factor levels was associated with the age-related increase in CHD incidence and mortality in both sexes but to a larger extent in women.
Key Words: aging • epidemiology • coronary disease • sex • risk factors
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