Sex differences in cardiovascular health status and long-term outcomes in a primary prevention cohort

Background — Poor cardiovascular health quantified by 8 health behaviors and factors is associated with incident cardiovascular disease (CVD). However, it is not clear if this association differs between women and men.

Objectives — The aim of the study was to determine whether the association between cardiovascular health status and incident CVD events differs by sex.

Methods — Adults enrolled in the Ontario Health Study (March 2009-December 2017) with no prior CVD were included. Cardiovascular health was assessed based on the presence of ideal diet, sleep, physical activity, smoking, body habitus, blood glucose, blood cholesterol, and blood pressure. CVD events were ascertained to March 31, 2023. The association between ideal, intermediate, and poor health and outcomes was assessed using age-adjusted, cause-specific models, including interaction terms for sex.

Results — The cohort consisted of 175,098 individuals (61.4% women, mean age 47 years). Compared to men, more women had ideal cardiovascular health (9.1% vs 4.6%), while fewer women had poor cardiovascular health (21.9% vs 30.5%). Compared to ideal cardiovascular health, the age-adjusted HR for intermediate cardiovascular health was 2.31 (95% CI: 1.72-3.11) in women, which was greater than the HR of 1.57 (95% CI: 1.16-2.11) in men. Similarly, the HR for poor cardiovascular health was 5.08 (95% CI:3.78-6.84) in women and nearly double the HR of 2.54 (95% CI: 1.89-3.41) in men (P < 0.01 for interaction).

Conclusions — In this primary prevention cohort, as cardiovascular health status declined, the relative impact on the future rate of CVD was greater for women than for men. This supports sex-specific health promotion strategies to improve health status and outcomes.