Sex-specific Trends in Midlife Coronary Heart Disease Risk and Prevalence

Background: While recent data indicate that stroke prevalence in women at midlife is double that of similarly aged men in the United States, little is known about current sex-specific trends in symptomatic cardiovascular disease. This study aimed to determine sex-specific midlife prevalence of myocardial infarction (MI) and risk of future coronary heart disease.

Methods: We assessed the sex-specific MI prevalence and the Framingham coronary risk score (FCRS) among US adults aged 35 to 54 years who participated in the National Health and Nutrition Examination Surveys (NHANES), cross-sectional, nationally representative surveys, during 1988 to 1994 and 1999 to 2004.

Results: In both epochs, men aged 35 to 54 years had a higher prevalence of MI than similarly aged women, but the gap narrowed in recent years as MI prevalence decreased among men and increased among women (2.5% vs 0.7% in NHANES 1988-1994 [P < .01] and 2.2% vs 1.0% in NHANES 1999-2004 [P < .01]). Among men, the mean FCRS showed an improving trend (8.6% in NHANES 1988-1994 vs 8.1% in NHANES 1999-2004 [P = .07]), while among women, the mean FCRS worsened (3.0% in NHANES 1988-1994 vs 3.3% in NHANES 1999-2004 [P = .02]). Temporal trends in FCRS components revealed that men had more improvements in vascular risk factors than women, but diabetes mellitus prevalence increased in both sexes.

Conclusions: Over the past 2 decades, MI prevalence has increased among midlife women, while declining among similarly aged men. Also, although the risk of future hard cardiovascular events remains higher in midlife men compared with midlife women, the gap has narrowed in recent years. Greater emphasis on vascular risk factor control in midlife women might help mitigate this worrisome trend.