Sex disparities in cardiovascular risk among older adults: insights from the Tehran cohort study (TeCS)

Cardiovascular disease (CVD) is the leading cause of death in Iran and is expected to increase with population aging. However, sex-specific data on CVD risk in older adults are limited. This study examined differences between men and women in major CVD risk factors, and predicted 10-year cardiovascular risk within the Tehran Cohort Study (TeCS). We analyzed data from 1,791 adults aged ≥ 65 years enrolled in the recruitment phase of the TeCS. The 10-year risk of CV events was estimated using SCORE2 for non-diabetic individuals aged 65–69 and SCORE2-OP for those aged ≥ 70. Utilizing SCORE2-Diabetes for diabetic individuals aged 65–69 was not feasible due to the lack of Hemoglobin A1C data, which led to the exclusion of this population from risk calculation. Sociodemographic correlates of CV risk were also assessed. A total of 1,791 participants with a mean age of 72.4 ± 6.5 years were included, of whom 52.5% were male. Men had a higher frequency of established coronary artery disease (CAD) than women (26.6% vs. 14.0%, P < 0.001). Women showed higher frequency of hypertension (62.7% vs. 51.2%, P < 0.001), diabetes (34.1% vs. 30.5%, P < 0.001), dyslipidemia (57.3% vs. 41.5%, P < 0.001), obesity (42.9% vs. 20.1%, P < 0.001), low physical activity (40.0% vs. 24.7%, P < 0.001), and metabolic syndrome (54.0% vs. 31.3%, P < 0.001), while, Smoking (21.9% vs. 5.9%, P < 0.001), opium use (10.7% vs. 1.3%, P < 0.001), and alcohol use (13.0% vs. 2.1%, P < 0.001) were more frequent in men. After excluding patients with missing data for risk calculation, the risk scores were calculated for 1,154 participants, with a median predicted 10-year CV risk of 17.22% [11.35, 26.87]. While the risk scores were almost comparable between men and women (18.23% vs. 16.09%), the high-risk status (10-year CV risk > 15%) was more frequent in men (62.8% vs. 53.9%, P < 0.001). Notably, higher education was associated with lower CV risk ( P < 0.001). Overall, older men in Tehran have higher rates of established CAD and a higher predicted risk, while women bear a heavier burden of modifiable risk factors. These findings highlight the importance of sex-specific prevention strategies in Iran’s aging population.