How CV risk factors influence future CHD, stroke rates in women
Cardiovascular risk factors have similar effects on the incidence of coronary heart disease (CHD) and ischemic stroke in women, researchers report in the first large-scale study of its kind in female patients.
The study, led by first author Maarten J. G. Leening, MD, PhD, and published in the Journal of the American Heart Association, compared data from 1,731 women with incident cardiovascular disease to those from 1,914 with a clean bill of health. Cardiovascular risk factors have differential effects on different manifestations of CVD, Leening, of Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues wrote—but studies exploring those effects have centered around men and more traditional risk factors.
“In many studies, CVD incidence represents the first manifestation among a variety of events combined into a composite endpoint,” Leening et al. wrote. “This is done under the assumption that cardiovascular risk factors contribute in a similar fashion to the development of different manifestations of CVD. Previous work, however, has shown that CVD manifests differentially in men and women.”
Indeed, past research has established CVD is more likely to manifest with stroke in women, while men see a higher likelihood for developing CHD.
To expand the current body of research, Leening and his team used data from the multi-ethnic Women’s Health Initiative Observational Study to track 24 risk factors—including non-traditional considerations like apolipoproteins, hemoglobin A1c, high-sensitivity C-reactive protein and tissue plasminogen activator antigen—in their study population.
During follow-up, 1,731 initially CVD-free women developed cardiac problems, including 703 cases of CHD, 871 instances of stroke and 157 other cardiovascular deaths. Of the strokes, 714 were ischemic.
Leening and colleagues said the direction of effect of all 24 risk factors was concordant for CHD and ischemic stroke, though the link was stronger with CHD. Some risk factors, like blood pressure, lipid levels and measures of inflammation, differed significantly when comparing hemorrhagic versus ischemic strokes.
“Multivariable adjusted hazard ratios per standard deviation increase in non-HDL cholesterol were 1.16 for CHD, 0.97 for ischemic stroke and 0.76 for hemorrhagic stroke,” the authors wrote. “Risk prediction models combining ischemic and hemorrhagic stroke into a single composite outcome have a poorer ability to identify individuals at increased risk of all stroke types combined because of the differences in risk factor profiles of ischemic and hemorrhagic stroke.”
Leening et al. said their results persisted after adjusting for age and ethnicity.
“In middle-aged and older women free of CVD, both traditional and newer cardiovascular risk factors have largely similar effects on the incidence of atherosclerotic CVD manifestations, although the magnitude of associations may vary,” they wrote. “Our findings suggest that CVD risk may be more accurately reflected when combined CVD or cerebrovascular outcomes are broken down into different first manifestations, or when the composite endpoint is restricted to ischemic outcomes only.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.