BackgroundCardiovascular disease mortality rates are well known to be lower in women than men and to increase with age. Whether these sex and age effects have changed over recent decades, and how much they differ by country, is unclear.MethodFrom the WHO Mortality Database, we obtained age-specific and sex-specific coronary heart disease (CHD) and stroke mortality rates for the world's most populous countries with data available between 1980 and 2010. We calculated age-specific, country-specific and period-specific men-to-women CHD and stroke mortality rate ratios for 26 countries and compared the differences between and within countries over time.ResultsCHD and stroke mortality decreased substantially between 1980 and 2010 in most countries, in both sexes. Mostly there was an attenuation of the effect of ageing over calendar time, more so in men than in women. CHD mortality was higher in men than in women throughout adulthood, but the magnitude of the difference varied by age. Men-to-women CHD mortality rate ratios were 4–5 in middle age (30–64 years) and 2 thereafter (65–89 years). Stroke mortality was more similar between sexes, with men-to-women stroke mortality rate ratios of around 1.5–2 until old age.ConclusionsWhile CHD and stroke mortality rates declined considerably between 1980 and 2010 in both sexes, there was some indication for stronger age-specific reductions in CHD in men than women. Mortality from CHD and stroke remains higher among men than women until old age across a range of economically, socially and culturally diverse countries.
BackgroundThere are substantial differences in the distribution of adipose tissue between women and men. We assessed the sex‐specific relationships and their differences between measures of general and central adiposity and the risk of incident myocardial infarction (MI).Methods and ResultsBetween 2006 and 2010, the UK Biobank recruited over 500 000 participants aged 40 to 69 years across the United Kingdom. During 7 years of follow‐up, 5710 cases of MI (28% women) were recorded among 265 988 women and 213 622 men without a history of cardiovascular disease at baseline. Cox regression models yielded adjusted hazard ratios for MI associated with body mass index, waist circumference, waist‐to‐hip ratio, and waist‐to‐height ratio. There was an approximate log‐linear relationship between measures of general and central adiposity and the risk of MI in both sexes. A 1‐SD higher in body mass index, waist circumference, waist‐to‐hip ratio, and waist‐to‐height ratio, respectively, were associated with hazard ratios (confidence intervals) for MI of 1.22 (1.17; 1.28), 1.35 (1.28; 1.42), 1.49 (1.39; 1.59), and 1.34 (1.27; 1.40) in women and of 1.28 (1.23; 1.32), 1.28 (1.23; 1.33), 1.36 (1.30; 1.43), and 1.33 (1.28; 1.38) in men. The corresponding women‐to‐men ratios of hazard ratios were 0.96 (0.91; 1.02), 1.07 (1.00; 1.14), 1.15 (1.06; 1.24), and 1.03 (0.97; 1.09).ConclusionsAlthough general and central adiposity measures each have profound deleterious effects on the risk of MI in both sexes, a higher waist circumference and waist‐to‐hip ratio conferred a greater excess risk of MI in women than in men. Waist‐to‐hip ratio was more strongly associated with the risk of MI than body mass index in both sexes, especially in women.
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