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American Journal of Epidemiology Advance Access originally published online on June 12, 2007
American Journal of Epidemiology 2007 166(4):403-412; doi:10.1093/aje/kwm115
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American Journal of Epidemiology © The Author 2007. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

The Female Advantage in Cardiovascular Disease: Do Vascular Beds Contribute Equally?

Isabella Kardys1, Rozemarijn Vliegenthart1,2, Matthijs Oudkerk2, Albert Hofman1 and Jacqueline C. M. Witteman1

1 Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands
2 Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands

Correspondence to Dr. J. C. M. Witteman, Department of Epidemiology and Biostatistics, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands (e-mail: j.witteman{at}erasmusmc.nl).

Received for publication December 18, 2006. Accepted for publication February 28, 2007.

The female advantage in coronary heart disease occurrence is not completely understood. To characterize gender differences in cardiovascular disease by vascular site, the authors compared degrees of coronary, carotid, peripheral, and aortic atherosclerosis in men and women aged ≥55 years from the population-based Rotterdam Study (Rotterdam, the Netherlands). Data were collected between 1997 and 2000. A subset of 2,013 participants had data on both coronary calcification and one or more measures of extracoronary atherosclerosis, including intima-media thickness (IMT), carotid plaques, ankle-arm index (AAI), and aortic calcification. The multivariable-adjusted male:female odds ratios for calcium score > 1,000 were 7.8 (95% confidence interval (CI): 3.2, 19.3), 5.4 (95% CI: 2.8, 10.2), and 3.0 (95% CI: 1.7, 5.2) in the lowest, middle, and highest age tertiles, respectively. For IMT > 1.0 mm, severe carotid plaques, AAI < 0.90, and severe aortic calcification, ratios did not decline with age. Overall multivariable-adjusted male:female odds ratios for these measures were 2.9 (95% CI: 2.0, 4.1), 2.0 (95% CI: 1.4, 2.8), 0.9 (95% CI: 0.7, 1.3), and 1.0 (95% CI: 0.8, 1.5), respectively. The authors conclude that the gender difference in atherosclerosis is larger in the coronary vessels than in other vascular beds. Remarkably, it is absent in the aorta and the lower-extremity vessels. Factors causing this site-specific gender difference require further investigation.

atherosclerosis; cardiovascular diseases; coronary disease; coronary vessels; risk factors; sex

Abbreviations: AAI, ankle-arm index; CI, confidence interval; HDL, high density lipoprotein; IMT, intima-media thickness


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