加拿大人口健康研究所Marjan Walli-Attaei团队对27个高中低收入国家在危险因素、治疗、心血管疾病发病率和死亡中的两性差异进行了分析。2020年5月20日出版的《柳叶刀》发表了这项成果。

一些主要来自高收入国家（HIC）的研究报告称，女性接受心血管疾病的护理（调查和治疗）比男性少，而且死亡风险更高。然而，很少有研究系统地报告危险因素、一级或二级预防药物的使用、心血管疾病的发生率或社区居民的死亡情况。鉴于大多数心血管疾病发生在中低收入国家（LMICs），因此有必要提供综合信息，来比较高、中、低收入国家基于社区的男女两性间的治疗和预后。

在这项前瞻性城市农村流行病学研究（PURE）中，2005年1月6日到2019年5月6日，研究组在27个国家的城市和农村社区招募了202072名年龄在35-70岁之间的参与者，其中女性的平均年龄为50.8岁，男性为51.7岁。研究组记录了有关参与者的社会人口统计学特征、危险因素、药物使用、心脏检查和干预措施的信息。168490名参与者参加了PURE三阶段的前两个，均接受了心血管疾病和死亡事件的前瞻性随访。

中位随访9.5年后，两种不同的风险评分显示女性的心血管疾病危险因素负担较低。与男性相比，女性更倾向于采取一级预防策略，例如采取一些健康的生活方式和使用经证实的药物。女性的心血管疾病和全因死亡率分别为每1000人年4.1例和4.5例，均显著低于男性（6.4例和7.4例）。

相比之下，在所有国家中，女性的二级预防治疗、心脏检查和冠状动脉血运重建率均低于男性。尽管如此，女性心血管事件发生率为每1000人年20.0例，显著低于男性（27.7例），发病后30天死亡率为22%，显著低于男性（28%）。无论先前是否有心血管疾病，中低收入国家中男女在治疗和预后方面的差异更为明显，但在高收入国家差异很小。

总之，在一级预防中，女性比男性更常治疗心血管疾病，但在二级预防中则相反。但无论有无心血管疾病，女性的结局始终比男性好。男女都应大力改善心血管疾病的预防和治疗，尤其是在中低收入国家。

附：英文原文

Title: Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study

Author: Marjan Walli-Attaei, Philip Joseph, Annika Rosengren, Clara K Chow, Sumathy Rangarajan, Scott A Lear, Khalid F AlHabib, Kairat Davletov, Antonio Dans, Fernando Lanas, Karen Yeates, Paul Poirier, Koon K Teo, Ahmad Bahonar, Felix Camilo, Jephat Chifamba, Rafael Diaz, Joanna A Didkowska, Vilma Irazola, Rosnah Ismail, Manmeet Kaur, Rasha Khatib, Xiaoyun Liu, Marta Mańczuk, J Jaime Miranda, Aytekin Oguz, Maritza Perez-Mayorga, Andrzej Szuba, Lungiswa P Tsolekile, Ravi Prasad Varma, Afzalhussein Yusufali, Rita Yusuf, Li Wei, Sonia S Anand, Salim Yusuf

Issue&Volume: 2020-05-20

Abstract: Background

Some studies, mainly from high-income countries (HICs), report that women receive less care (investigations and treatments) for cardiovascular disease than do men and might have a higher risk of death. However, very few studies systematically report risk factors, use of primary or secondary prevention medications, incidence of cardiovascular disease, or death in populations drawn from the community. Given that most cardiovascular disease occurs in low-income and middle-income countries (LMICs), there is a need for comprehensive information comparing treatments and outcomes between women and men in HICs, middle-income countries, and low-income countries from community-based population studies.

Methods

In the Prospective Urban Rural Epidemiological study (PURE), individuals aged 35–70 years from urban and rural communities in 27 countries were considered for inclusion. We recorded information on participants' sociodemographic characteristics, risk factors, medication use, cardiac investigations, and interventions. 168490 participants who enrolled in the first two of the three phases of PURE were followed up prospectively for incident cardiovascular disease and death.

Findings

From Jan 6, 2005 to May 6, 2019, 202072 individuals were recruited to the study. The mean age of women included in the study was 50·8 (SD 9·9) years compared with 51·7 (10) years for men. Participants were followed up for a median of 9·5 (IQR 8·5–10·9) years. Women had a lower cardiovascular disease risk factor burden using two different risk scores (INTERHEART and Framingham). Primary prevention strategies, such as adoption of several healthy lifestyle behaviours and use of proven medicines, were more frequent in women than men. Incidence of cardiovascular disease (4·1 [95% CI 4·0–4·2] for women vs 6·4 [6·2–6·6] for men per 1000 person-years; adjusted hazard ratio [aHR] 0·75 [95% CI 0·72–0·79]) and all-cause death (4·5 [95% CI 4·4–4·7] for women vs 7·4 [7·2–7·7] for men per 1000 person-years; aHR 0·62 [95% CI 0·60–0·65]) were also lower in women. By contrast, secondary prevention treatments, cardiac investigations, and coronary revascularisation were less frequent in women than men with coronary artery disease in all groups of countries. Despite this, women had lower risk of recurrent cardiovascular disease events (20·0 [95% CI 18·2–21·7] versus 27·7 [95% CI 25·6–29·8] per 1000 person-years in men, adjusted hazard ratio 0·73 [95% CI 0·64-0·83]) and women had lower 30-day mortality after a new cardiovascular disease event compared with men (22% in women versus 28% in men; p<0·0001). Differences between women and men in treatments and outcomes were more marked in LMICs with little differences in HICs in those with or without previous cardiovascular disease.

Interpretation

Treatments for cardiovascular disease are more common in women than men in primary prevention, but the reverse is seen in secondary prevention. However, consistently better outcomes are observed in women than in men, both in those with and without previous cardiovascular disease. Improving cardiovascular disease prevention and treatment, especially in LMICs, should be vigorously pursued in both women and men.

DOI: 10.1016/S0140-6736(20)30543-2

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30543-2/fulltext