Gender gap in some cardiovascular disease risk factors widening in young adults, new study finds

The gender gap in blood pressure, physical activity and smoking has widened among young adults in the United States, new research shows, suggesting that prevention approaches should be carefully tailored to help people achieve ideal lifelong cardiovascular health.

Overall heart health stayed about the same in more than 10,000 people ages 20 to 39 from 2007 to 2018, and women had better overall scores than men, according to the study, published in the Journal of the American Heart Association.

But when the researchers looked at individual risk factors, remarkable trends emerged.

The percentage of young men with normal blood pressure decreased from 54% in 2007 to 47% in 2018, but remained stable at about 80% among young women.

Optimal physical activity — at least three days a week with moderate-to-vigorous activity — fell in women, from 57% to 49%. But in men it remained the same, about half got enough exercise.

Non-smoking was more common in young women, rising from 64% to 71%, but remained the same in men, at about half.

Risk factors for women and men were persistently suboptimal, the researchers found. For example, only about a third reported having a healthy body mass index and following a healthy diet as of 2018.

“Cardiovascular disease still holds the dubious distinction of being the single largest killer in the US and the world for the past two decades,” said lead author of the study, Dr. Pradeep Natarajan, director of preventive cardiology at Massachusetts General Hospital in Boston. Risk factors “earlier in life increase future risk of cardiovascular disease.”

The researchers found even larger gaps for some risk factors in the young adults when they pooled data from the decade based on race. For example, 84% of Hispanic women, but only 53% of Hispanic men in the study, had normal blood pressure. For physical activity, 65% of black women had reached the ideal level compared to 50% of black men. Among white people, ideal physical activity was slightly more common in men.

“Identifying these problems earlier in life and then addressing them earlier in life will bring significant benefits later on,” Natarajan said. “But risk identification earlier in life is really not at the forefront of clinical medicine.”

Current models to predict heart risk usually work best for people ages 40 to 70, he said, and research in adults under 40 is lacking.

dr. Carissa Baker-Smith, director of pediatric preventive cardiology at Nemours Children’s Health in Wilmington, Delaware, said recommendations for monitoring cardiac risk factors in children and young adults are not well followed in clinical practice.

“Current guidelines recommend that cholesterol levels be checked between ages 9 and 11 and again between ages 17 and 21” if the child has no known family history of high cholesterol and early heart disease, rather if there is a known family history, Baker-Smith said. who was not involved in the investigation. “Screen for” [cardiovascular disease] risk factors is not something that is universally performed in young adults and adolescents. I believe one of the challenges is that general providers may not fully understand how to interpret or manage the results.”

Experts say more research is needed to better understand what drives differences in cardiac risk factors — for example, whether people have primary care physicians and how often they see them, as well as the impact of quality of care, socioeconomic status and other social determinants of health. .

“I think understanding the drivers behind those differences would lead to better intervention strategies,” said Baker-Smith, who said it would also be helpful for a study to track individuals over time to better understand how risk factors earlier in life affect heart health. later.

That was a limitation of the current study, which looked back at existing national research data. Another limitation noted by the researchers was that the gender and race classifications did not include non-binary genders or details about race and ethnicity.

The study’s lead author, Dr. So Mi Cho, hopes the findings will make doctors and the public aware of the importance of “primordial” prevention — preventing the development of risk factors rather than addressing them once they are discovered.

“The motivation behind this study was to emphasize the sooner the better,” said Cho, a postdoctoral researcher at the Broad Institute of MIT and Harvard in Cambridge, Massachusetts. “If you could know sooner, the more efficient and effective would be prevention approaches, rather than letting it deteriorate for a long time and finding out much later in life.”

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