Worsening trends in modifiable cardiovascular risk factors among patients hospitalised for cardiovascular disease in Spain (2007–2022): a nationwide sex-specific analysis

Aims To assess sex-specific temporal changes in prevalence of cardiovascular risk factors (CVRF) in patients admitted for cardiovascular diseases (CVD) in Spain, a high-income country with universal health care, from 2007 to 2022. Methods A retrospective, population-based analysis using the Spanish Minimum Basic Data Set, including all adults (≥18 years) hospitalised with a principal diagnosis of CVD was performed. Analyses focused on acute myocardial infarction (STEMI, NSTEMI), stroke, heart failure (HF), and aortic stenosis (AS). Temporal trends in the prevalence of the CVRF throughout the study period, for CVD in general and for each specific CVD (, both in the overall sample and in men and women, were studied using the join-point jump regression method. Results There were 6,734,967 hospital admissions for CVD, 3,776,811 (56.1%) in men and 2,958,156 (43.9%) in women. Women were older (79; IQR: 70-86 vs. 72; IQR 61-81 years; p<0,001). Hypertension was present in the 43.8%, dyslipidaemia in the 36.9% and diabetes mellitus in the 32% of episodes, without differences clinically relevant between women and men. However, smoking habit (19.8%) and alcohol consumption (4%) were significantly and clinically (standardised difference in means-SDM) relevant more frequent in men (29.5% vs 7.5% and 6.6% vs 0.6%, respectively), and obesity (11.5%) in women (13.7% vs 9.8%) (figure 1). Over time, prevalence of most CVRF increased in both sexes, except for hypertension, which declined in both (figure 2). Notably, particularly concerning increases in obesity, dyslipidaemia and smoking were observed among women (figure 2).The prevalence of CVRFs increased between 2007-2022 for the whole population, except for hypertension which significantly decreased (average annual percent change: -1,9; CI: 2.7; -1.1), and smoking without a statistically significant trend (AAPC: 0,7; CI: -0.2; 1.7). Women showed statistically higher increases than men for alcohol consumption (8,5; CI: 6.5 ; 10.5 vs 4,3; CI: 3.6 ; 5.1); smoking (5,3; CI: 4.8 ; 5.8 vs 0,2; CI: -0.8 ; 1.3) and a more pronounced decline for hypertension (-2,9; CI: -3.9 ; -2.0 vs -1,1; CI: -1.8 ; -0.5). Meanwhile men showed higher increases for obesity (5,7; CI: 5.2; 6.2 vs 3,3; CI: 2.9; 3.8) and diabetes mellitus (1,8; CI: 1.5; 2.2 vs 0,3; CI: 0.0; 0.6). Conclusions Our results underscore persistent current and over the time sex-specific differences in the prevalence of CVRF in Spain from 2007 to 2022. Men consistently exhibited higher rates of smoking and alcohol consumption, while prevalence of obesity/overweight and hypertension was higher in women. Despite women having lower rates of smoking and alcohol consumption than men, adverse trends in obesity, dyslipidaemia, and smoking among women are narrowing historical sex differences. These findings highlight the need for sex-sensitive prevention strategies to reduce cardiovascular burden in ageing populations.