Abstract 4139063: Sex Differences in Age of Onset of Cardiovascular Disease and Subtypes: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Historically, coronary heart disease (CHD) has been reported to develop about ten years earlier in males than females. However, whether this gap has narrowed in a contemporary sample and whether similar sex differences in age of onset exist for other cardiovascular disease (CVD) subtypes (stroke and heart failure [HF]) that are becoming more common is not known. Methods: Participants were enrolled in the CARDIA study between the ages of 18-30 years in 1985-1986. Sex differences in the cumulative incidence functions of premature CVD (defined as onset before 65 years), overall and for each subtype including CHD, HF, and stroke, were compared using Gray’s test. Results: Among 5115 participants (54.5% female, 51.6% Black), the mean age at study enrollment was 24.8 years (SD: 3.7). Over a median follow-up of 34.0 years (IQR 33.8, 35.7), cumulative incidence of total CVD, CHD, and HF was significantly higher in males compared with females (p<0.05 for all). For total CVD, males reached an incidence of 5% at a younger age than females (50.1 versus 57.3 years, Figure). CHD was the most frequent CVD subtype, and an incidence of 2% occurred at a younger age among males compared with females (48.3 vs. 58.5). For HF, an incidence of 1% occurred among males by age 48.4 compared with 51.7 for females. For stroke, an incidence of 2% occurred at similar ages for males and females (56.3 and 55.1 years). Cumulative incidence for CVD, CHD, HF, and stroke, respectively, by age 50, was 5.0%, 2.7%, 1.3%, and 1.3% for males and 3.0%, 1.0%, 1.0%, and 1.3% for females. In a secondary race-stratified analysis, Black males and females reached cumulative incidences of 6.3% and 4.5%, respectively, for total CVD by age 50, in comparison to 3.7% and 1.4% among White males and females. Conclusion: Males reached 5% incidence of total CVD seven years earlier than females, with the greatest difference observed in age of onset for CHD. Age of onset for HF and stroke were similar between males and females. This may inform sex-specific prevention strategies for young adults.