Sex Differences in BP/CVD Associations

Analyses of community-based cohort studies suggested increasing cardiovascular disease (CVD) risk beginning at lower thresholds of systolic blood pressure (SBP) for women than for men. The study included 27 542 participants (54% women) without baseline CVD who had standardized SBP measurements performed in 1 of 4 community-based cohort studies. Over 28±12 years, 7424 participants (44% women) developed nonfatal or fatal CVD: 3405 myocardial infarction (MI), 4081 heart failure (HF), and 1901 stroke events. In sex-pooled analyses, the threshold for incident MI and HF was 120 to 129 mm Hg and for stroke was 130 to 139 mm Hg. In sex-specific analyses, incidence of CVD proportionately increased beginning at a lower range of SBP in women compared with men. In multivariable-adjusted analyses, presence of SBP 100 to 109 mm Hg relative to SBP <100 mm Hg was associated with incident CVD in women but not men, in whom risk was seen at SBP 130 to 139 mm Hg. There were similarly consistent sex-specific results for MI, HF, and stroke. In restricted splines regression of SBP as a continuous rather than a categorical variable, findings were similar. Results were also similar in analyses stratified by age, race, and cohort; excluding participants taking antihypertensive medication; excluding diastolic BP adjustment; and relating diastolic BP with CVD risk. Multiplicative sex interaction terms indicated consistently larger associations in women than men across all outcomes. In analyses of age interactions, the association of SBP with CVD risk was more pronounced in younger versus older women (median age <52 versus ≥52 years), whereas no age interaction was seen for men. The findings suggest the possible need for a lower sex-specific definition of optimal SBP for women. It is well known that BP levels in healthy adults are on average lower in women than men. Source: https://www.ahajournals.org/