Key result
Female sex links to better CVH, while marriage and larger household size associate with poorer health.
Why the study?
Sex and gender-based differences in cardiovascular health had not been examined in low- and middle-income countries, including South Asian populations.
Cross-Sectional (n=33,106)
Yes
In South Asian populations, female sex is associated with better cardiovascular health, but gender-related factors such as marriage and large household size negatively impact cardiovascular health and increase CVD risk, particularly in men.
Should not yet alter CV risk assessment by sex or marital status; leaves open longitudinal studies of household factors in South Asians.
Background Sex and gender-based differences in cardiovascular health (CVH) has been explored in the context of high-income countries.However, these relationships have not been examined in low-and middle-income countries.The main aim of this study was to examine how sex and gender-related factors are associated with cardiovascular risk factors of people in South Asian countries. MethodsWe conducted a retrospective analysis of the World Health Organization's "STEPwise approach to surveillance of risk factors for non-communicable disease" or "STEPS" from six South Asian countries, surveys conducted between 2014-2019.The main outcomes were CVH as measured by a composite measure of STEPS-HEART health index (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes and hypertension), values ranging from 0 (worst) to 6 (best or ideal) and self-reported occurrence of cardiovascular disease (ie, heart attack and stroke).Multivariate linear and logistic regression models were performed.Multiple imputation with chained equations was performed. ResultsThe final analytic sample consisted of 33 106 participants (57.5% females).The mean STEPS-HEART index score in the South Asian population was 3.43 [SD: 0.92].Female sex (β: 0.05, 95% confidence interval (CI) = 0.01-0.08,P < 0.05) was significantly associated with better CVH compared to males.Being married (β male = -0.30,95% CI = -0.37,-0.23 vs β female = -0.23,95% CI = -0.29,-0.17; P < 0.001) and having a household size ≥5 (β male = -0.15,95% CI = -0.24,-0.06 vs β female = -0.11,95% CI = -0.16,-0.04; P < 0.01) were associated with poorer CVH, more so in males.Being married was also associated with high risk of CVD (OR male = 2.54, 95% CI = 1.68-3.86,P < 0.001 vs OR female = 1.19, 95% CI = 0.84-1.68,P = 0.31), significant in males.Conclusions Among the South Asian population, being female may be advantageous in having an ideal CVH.However, gender-related factors such as marital status and large household size were associated with poorer CVH and greater risk of CVD, regardless of sex.
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Dev et al. (2022) conducted a cross-sectional in Cardiovascular health and disease (n=33,106). Female sex and gender-related factors vs. Male sex and reference gender categories was evaluated on Cardiovascular health (STEPS-HEART health index score) (β 0.05, 95% CI 0.01-0.08, p=<0.05). Female sex was significantly associated with better cardiovascular health compared to males (β 0.05), while being married and larger household size were associated with poorer cardiovascular health.
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