Sex-Differences In The Prevalence Of Low Clinical Cardiovascular Health From Childhood To Middle-Age

Introduction: This study examines sex differences in the prevalence of low clinical cardiovascular health (CVH) scores from ages 8-50 years old. Methods: Five cardiovascular cohorts (Bogalusa, Young Finns, HB!, CARDIA, and STRIP) were used to create a pooled cohort spanning from ages 8 to 50 years old. The American Heart Association criteria for poor, intermediate and ideal levels for 4 CVH factors (blood pressure, BMI, cholesterol, and glucose) were summed to calculate a clinical CVH score (range 0-8; higher being more ideal). Sex differences in the prevalence rates of low clinical CVH by age group (defined as a score ≤3) were estimated using logistic regression models. Results: Sex differences were examined among 9,386 participants with data on clinical CVH (56% female, 66% White and average follow-up time of 23 yrs). The prevalence of low clinical CVH increased for both men and women with age from 0.72% at age 8-14 yrs to 15% at 45-50 yrs of age in women and from 0.44% at ages 8-14 yrs to over 23% at ages 45-50 yrs in men. There were no significant sex differences in the prevalence of low clinical CVH at younger ages (8-20 years old, p>0.05). Between the ages of 21-26 years old, males were 2 times more likely to have low clinical CVH than women (odds ratio [OR] 2.2, 95% confidence interval [CI], 1.4-3.4). Sex differences in the prevalence of low clinical CVH persisted through adulthood and with only a slight decrease by ages 45-50 years old (OR 1.6, 95%CI 1.4-1.9). Conclusions: Sex differences in the prevalence of low clinical CVH change over the lifetime. In childhood the prevalence of low clinical CVH is similar. By young adulthood, men are more than twice more likely to have low clinical CVH than women; that sex difference is maintained throughout middle age. Understanding the reasons for the growing sex differences in the prevalence of low clinical CVH with age may help to identify targets for primordial prevention, especially prevention strategies to target young men.