Key result
HF mortality gender gap narrows in patients ≥75 years, while CV and MI gaps remain stable.
Why the study?
Cardiovascular disease differentially impacts men versus women, prompting the hypothesis of a gender gap in CV, MI, and HF mortality.
Observational (n=2,802,935)
Over the last two decades in Spain, overall cardiovascular and myocardial infarction mortality maintained a stable gender gap with higher rates in men, whereas the gender gap in heart failure mortality significantly decreased.
May indicate evolving HF sex differences in elderly; leaves open causal drivers and targeted interventions.
Background Cardiovascular (CV) disease has a differential impact in men vs. women being the incidence and mortality of myocardial infarction (MI) or stroke clearly different. We hypothesized that could be a gender gap in CV mortality and the 2 leading forms of CV disease: MI or heart failure (HF) Methods We performed an analysis of the Spanish National Institute of Health (INE) statistics using age-standardized mortality rates (ASMR) /100.000 persons. The relative differences in mortality rates in men vs. women were calculated to assess the gender-gap. Joinpoint regression models were fitted to analyze temporal trends during the study period and for the difference in rates of women vs. men and in the following groups of age: <50, 50-74 and ≥75 years. Results Between 2000 and 2022 there were 2,802,935 CV deaths; 431,707 (15.4%) were attributable to MI and 432,184 (15.4%) to HF. As shown in the figure, CV, MI and HF mortality decreased in men and women. The gender gap remained stable for CV mortality and MI being the mortality higher in men (negative gender ratio); in contrast, the gender gap in HF mortality decreased and changed from positive to negative (figure, bottom right). En joinpoint regression results are presented in figure 2. CV mortality gender gap decreased significantly in youngest subjects until 2019 and then remained stable, had no changes in subjects with age 50-74 but in those ≥75 years decreased between 2004-2013 and increased significantly afterwards. The gender gap in MI mortality had significant reduction in the age groups although the decrease in ≥ 75 years was statistically significant after 2023; in contrast, no change in the gender gap for MI was observed in subjects <50 after 2017. The gender gap in HF mortality had differential trends in the 3 age groups: it did not change in subjects <50; in subjects 50-74 increased between 2000-2006, it decreased 2006-2011 and increased afterwards; it decreased significantly, and with the highest slope, in subjects ≥75 years. Conclusions There is an evident gender gap in CV, MI and HF mortality that followed differentiated trends in the last 2 decades in Spain. The highest the reduction in the gender gap was observed HF mortality due to effect in elderly patients.Time series in ASMR and gender-gap Joint poit regression results
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Cordero et al. (2025) conducted an observational in Cardiovascular disease mortality (n=2,802,935). Male gender vs. Female gender was evaluated on Gender gap in cardiovascular, myocardial infarction, and heart failure mortality. Between 2000 and 2022 in Spain, the gender gap remained stable for overall CV and MI mortality (higher in men), whereas the gender gap in HF mortality decreased, particularly in patients ≥75 years.
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