1Deutsches Herzzentrum der Charité Department of Cardiology, Angiology and Intensive Care Medicine (CCM) Berlin, Deutschland; 2Charité University Medicine, Campus Mitte Department of Institute for Biometry and Clinical Epidemiology Berlin, Deutschland; 3ias PREVENT GmbH Berlin, Deutschland; 4Deutsches Herzzentrum der Charite (DHZC) Klinik für Kardiologie, Angiologie und Intensivmedizin | CVK Berlin, Deutschland
Background
Cardiovascular (CV) disease is the leading cause of death in both women and men worldwide. Despite this commonality, there are relevant sex-specific differences with regards to pathophysiology, risk constellations, clinical presentation, and treatment of CV disease. Consideration of differences in CV risk factors in men and women is crucial to enable an individualized, patient-centered preventive approach. Less studied risk factors such as work stress have hardly been considered so far. Identification of sex-specific CV risk factors in the working population could enable effective preventive measures in women and men.
Methods
In a cooperation project between Charité and a preventive health care company (ias PREVENT GmbH), which has been conducting preventive medical check-ups for employees of German companies for more than 40 years, 80 000 data records from 2012 and 2021 were retrospectively analyzed. In a first step, the sex-specific occurrence of classic CV risk factors, as well as newly discussed factors such as stress exposure or the concentration of inflammation parameters for women and men (±SD), including the women-specific risk ratio, were determined.
Results
75,622 examinations conducted on 58,237 men and 17,384 women were analyzed. Mean age was 50.05 years (±7.58) for women and 51.55 years (±7.71) for men. The mean BMI was 26.1 kg/m² (±4.06) in 72,321 exams. 14.4% of men and 13.7% of women had a BMI >30 kg/m² (RR 0.95; 95% CI 0.94-0.96). Hypercholesterolemia with LDL ≥115mg/ml occurred in 73.6% of men and 58.1% of women (RR 0.79; 95% CI 0.77-0.81). The mean HbA1c value was 5.4% (±0.53) in 70,645 examinations. 1.9% of men and 1.0% of women (RR 0.549; 95% CI 0.548-0.550) showed an HbA1c ≥6.5%. 20.1% of men and 13.3% of women had a blood pressure ≥140 mmHg (RR 0.66; 95% CI 0.658-0.667). 32.3% of women and 31.9% of men reported smoking at the time of the survey or in the past (RR 1.01, 95% CI 1.00-1.03). 51.3% of men reported a medium level of stress and 36.0% a high stress level, while 55.5% of women reported a medium level of stress and 30.4% a high level (RR for high stress 0.86; 95% CI 0.85-0.87). The mean value of high sensitivity-CRP (hs-CRP) was not elevated in both groups with 1.57 mg/l in men and 1.98 mg/l in women (normal value 3 mg/l).
Conclusion
The risk factor analysis of this large cohort of working people in Germany shows relevant sex-specific differences in classic and newer, less established, CV risk factors. Men suffered more often from hypercholesterolemia, diabetes, and arterial hypertension. The subjectively assessed stress level was more frequently in the high range for men than for women. In this cohort, women smoked more often than men. The incidence of obesity and the measured level of hs-CRP were comparable in women and men. This study forms the basis for investigating the relationship between risk factors and the occurrence of CV disease in the working population and may improve prevention approaches for working people in the future.