Sex-specific Lifetime Risk of Cardiovascular Events.: The EPIC-Norfolk Prospective Population Cohort Study

Tiberiu Pana; Mamas A Mamas; Nicholas J. Wareham; Kay-Tee Khaw; Dana Dawson; Phyo Kyaw Myint

doi:10.1093/eurjpc/zwad283

Sex-specific Lifetime Risk of Cardiovascular Events. The EPIC-Norfolk Prospective Population Cohort Study

Tiberiu Pana^* (Corresponding Author), Mamas A Mamas, Nicholas J. Wareham, Kay-Tee Khaw, Dana Dawson, Phyo Kyaw Myint

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

2 Downloads (Pure)

Abstract

Background and Aims. Better understanding of sex differences in cardiovascular disease (CVD) is essential in tailoring appropriate preventative strategies. Using a large population-based study with follow-up >25 years, we aimed to determine sex5 specific lifetime risks of incident CVD and cardiovascular mortality amongst populations with and without prevalent CVD.

Methods. Participants were drawn from the European Prospective Investigation into Cancer (EPIC)-Norfolk and followed up for a median of 26.2 years. Sex-specific lifetime risks were ascertained accounting for the competing risk of death. Models were adjusted for ethnicity and time-updated covariates: material deprivation, cardiovascular risks, lifestyle factors, comorbidities and medication.

Results. 23,859 participants (54.5% women; mean age (standard deviation) 59.2 13 (9.3) years at baseline) were included. Adjusted lifetime risks of incident CVD were higher in men than in women (69.1% versus 57.7% at age 75): cause-specific hazard ratio (cHR) (99% confidence interval) - 1.49(1.41-1.57), while the risks of cardiovascular mortality at age 75 were 4.4% (M) and 3.1% (F): cHR-1.42(1.31-17 1.54). Myocardial infarction (MI) was the predominant first presentation in men until the 8th decade. In women, the first CVD manifestations after their 6th 18 decade were predominantly atrial fibrillation (AF) and stroke. The male-associated excess relative risks of incident CVD and cardiovascular mortality were halved in people with prevalent CVD.

Conclusions. We characterised the sex-specific lifetime cardiovascular risks in a large cohort. Men had substantially higher risk of incident CVD and CV mortality than women, which was attenuated amongst people with prevalent CVD. Our findings provide an evidence base for sex-specific cardiovascular prevention.

Original language	English
Article number	zwad283
Pages (from-to)	230-241
Number of pages	12
Journal	European Journal of Preventive Cardiology
Volume	31
Issue number	2
Early online date	30 Nov 2023
DOIs	https://doi.org/10.1093/eurjpc/zwad283
Publication status	Published - 1 Jan 2024

Bibliographical note

Open Access via the OUP Agreement

ACKNOWLEDGEMENTS
We are grateful to all the participants who have been part of the project and to the many members of the study teams at the University of Cambridge who have enabled this research. We would like to acknowledge the principal investigators and staff of the EPIC-Norfolk study. We would also like to thank Dr Graham Horgan, PhD (Principal Consultant for Human Health and Nutrition, Biomathematics & Statistics Scotland) for his help and support with the statistical analyses.
FUNDING
The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK (C864/A14136).

Data Availability Statement

The data underlying this study are available from the EPIC-Norfolk Steering Committee upon reasonable request to the authors. The Stata code used to perform the analyses has been supplied as Supplementary material online (see Supplementary material online, File S1).

Keywords

Cardiovascular disease
cardiovascular mortality
sex differences
myocardial infarction
stroke
heart failure
atrial fibrillation
peripheral artery disease

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1093/eurjpc/zwad283Licence: CC BY-NC

Pana_etal_ESC_Sex_Specific_Lifetime_VoR
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Final published version, 855 KBLicence: CC BY-NC

Cite this

@article{dc266488d6964bc5a14e578b14b4a73e,

title = "Sex-specific Lifetime Risk of Cardiovascular Events.: The EPIC-Norfolk Prospective Population Cohort Study",

abstract = "Background and Aims. Better understanding of sex differences in cardiovascular disease (CVD) is essential in tailoring appropriate preventative strategies. Using a large population-based study with follow-up >25 years, we aimed to determine sex5 specific lifetime risks of incident CVD and cardiovascular mortality amongst populations with and without prevalent CVD.Methods. Participants were drawn from the European Prospective Investigation into Cancer (EPIC)-Norfolk and followed up for a median of 26.2 years. Sex-specific lifetime risks were ascertained accounting for the competing risk of death. Models were adjusted for ethnicity and time-updated covariates: material deprivation, cardiovascular risks, lifestyle factors, comorbidities and medication.Results. 23,859 participants (54.5% women; mean age (standard deviation) 59.2 13 (9.3) years at baseline) were included. Adjusted lifetime risks of incident CVD were higher in men than in women (69.1% versus 57.7% at age 75): cause-specific hazard ratio (cHR) (99% confidence interval) - 1.49(1.41-1.57), while the risks of cardiovascular mortality at age 75 were 4.4% (M) and 3.1% (F): cHR-1.42(1.31-17 1.54). Myocardial infarction (MI) was the predominant first presentation in men until the 8th decade. In women, the first CVD manifestations after their 6th 18 decade were predominantly atrial fibrillation (AF) and stroke. The male-associated excess relative risks of incident CVD and cardiovascular mortality were halved in people with prevalent CVD.Conclusions. We characterised the sex-specific lifetime cardiovascular risks in a large cohort. Men had substantially higher risk of incident CVD and CV mortality than women, which was attenuated amongst people with prevalent CVD. Our findings provide an evidence base for sex-specific cardiovascular prevention.",

keywords = "Cardiovascular disease, cardiovascular mortality, sex differences, myocardial infarction, stroke, heart failure, atrial fibrillation, peripheral artery disease",

author = "Tiberiu Pana and Mamas, {Mamas A} and Wareham, {Nicholas J.} and Kay-Tee Khaw and Dana Dawson and Myint, {Phyo Kyaw}",

note = "Open Access via the OUP Agreement ACKNOWLEDGEMENTS We are grateful to all the participants who have been part of the project and to the many members of the study teams at the University of Cambridge who have enabled this research. We would like to acknowledge the principal investigators and staff of the EPIC-Norfolk study. We would also like to thank Dr Graham Horgan, PhD (Principal Consultant for Human Health and Nutrition, Biomathematics & Statistics Scotland) for his help and support with the statistical analyses. FUNDING The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK (C864/A14136).",

year = "2024",

month = jan,

day = "1",

doi = "10.1093/eurjpc/zwad283",

language = "English",

volume = "31",

pages = "230--241",

journal = "European Journal of Preventive Cardiology",

issn = "2047-4873",

publisher = "Oxford University Press (OUP)",

number = "2",

}

TY - JOUR

T1 - Sex-specific Lifetime Risk of Cardiovascular Events.

T2 - The EPIC-Norfolk Prospective Population Cohort Study

AU - Pana, Tiberiu

AU - Mamas, Mamas A

AU - Wareham, Nicholas J.

AU - Khaw, Kay-Tee

AU - Dawson, Dana

AU - Myint, Phyo Kyaw

N1 - Open Access via the OUP Agreement ACKNOWLEDGEMENTS We are grateful to all the participants who have been part of the project and to the many members of the study teams at the University of Cambridge who have enabled this research. We would like to acknowledge the principal investigators and staff of the EPIC-Norfolk study. We would also like to thank Dr Graham Horgan, PhD (Principal Consultant for Human Health and Nutrition, Biomathematics & Statistics Scotland) for his help and support with the statistical analyses. FUNDING The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK (C864/A14136).

PY - 2024/1/1

Y1 - 2024/1/1

N2 - Background and Aims. Better understanding of sex differences in cardiovascular disease (CVD) is essential in tailoring appropriate preventative strategies. Using a large population-based study with follow-up >25 years, we aimed to determine sex5 specific lifetime risks of incident CVD and cardiovascular mortality amongst populations with and without prevalent CVD.Methods. Participants were drawn from the European Prospective Investigation into Cancer (EPIC)-Norfolk and followed up for a median of 26.2 years. Sex-specific lifetime risks were ascertained accounting for the competing risk of death. Models were adjusted for ethnicity and time-updated covariates: material deprivation, cardiovascular risks, lifestyle factors, comorbidities and medication.Results. 23,859 participants (54.5% women; mean age (standard deviation) 59.2 13 (9.3) years at baseline) were included. Adjusted lifetime risks of incident CVD were higher in men than in women (69.1% versus 57.7% at age 75): cause-specific hazard ratio (cHR) (99% confidence interval) - 1.49(1.41-1.57), while the risks of cardiovascular mortality at age 75 were 4.4% (M) and 3.1% (F): cHR-1.42(1.31-17 1.54). Myocardial infarction (MI) was the predominant first presentation in men until the 8th decade. In women, the first CVD manifestations after their 6th 18 decade were predominantly atrial fibrillation (AF) and stroke. The male-associated excess relative risks of incident CVD and cardiovascular mortality were halved in people with prevalent CVD.Conclusions. We characterised the sex-specific lifetime cardiovascular risks in a large cohort. Men had substantially higher risk of incident CVD and CV mortality than women, which was attenuated amongst people with prevalent CVD. Our findings provide an evidence base for sex-specific cardiovascular prevention.

AB - Background and Aims. Better understanding of sex differences in cardiovascular disease (CVD) is essential in tailoring appropriate preventative strategies. Using a large population-based study with follow-up >25 years, we aimed to determine sex5 specific lifetime risks of incident CVD and cardiovascular mortality amongst populations with and without prevalent CVD.Methods. Participants were drawn from the European Prospective Investigation into Cancer (EPIC)-Norfolk and followed up for a median of 26.2 years. Sex-specific lifetime risks were ascertained accounting for the competing risk of death. Models were adjusted for ethnicity and time-updated covariates: material deprivation, cardiovascular risks, lifestyle factors, comorbidities and medication.Results. 23,859 participants (54.5% women; mean age (standard deviation) 59.2 13 (9.3) years at baseline) were included. Adjusted lifetime risks of incident CVD were higher in men than in women (69.1% versus 57.7% at age 75): cause-specific hazard ratio (cHR) (99% confidence interval) - 1.49(1.41-1.57), while the risks of cardiovascular mortality at age 75 were 4.4% (M) and 3.1% (F): cHR-1.42(1.31-17 1.54). Myocardial infarction (MI) was the predominant first presentation in men until the 8th decade. In women, the first CVD manifestations after their 6th 18 decade were predominantly atrial fibrillation (AF) and stroke. The male-associated excess relative risks of incident CVD and cardiovascular mortality were halved in people with prevalent CVD.Conclusions. We characterised the sex-specific lifetime cardiovascular risks in a large cohort. Men had substantially higher risk of incident CVD and CV mortality than women, which was attenuated amongst people with prevalent CVD. Our findings provide an evidence base for sex-specific cardiovascular prevention.

KW - Cardiovascular disease

KW - cardiovascular mortality

KW - sex differences

KW - myocardial infarction

KW - stroke

KW - heart failure

KW - atrial fibrillation

KW - peripheral artery disease

U2 - 10.1093/eurjpc/zwad283

DO - 10.1093/eurjpc/zwad283

M3 - Article

C2 - 38031203

SN - 2047-4873

VL - 31

SP - 230

EP - 241

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

IS - 2

M1 - zwad283

ER -