Sex-specific cardiovascular risk profiles and gaps in Korea

Background Cardiovascular disease (CVD), the leading global cause of death, disproportionately affects women, who show an age-related increase in risk factor burden and often delayed care than men. Sex differences in cardiovascular risk profiles are well known, however, less is known about sex-specific gaps in risk factors and management of the risk factors in Asia. Purpose To investigate sex differences in the prevalence, awareness, treatment, and control of major CVD risk factors in Korea between 2013 and 2024. Methods We analyzed data from adults aged ≥20 years using Korea National Health and Nutrition Examination Survey between 2013 and 2024. Age-standardized prevalence was estimated separately for women and men using direct standardization to the 2024 Korean standard population. Risk factors included current smoking, obesity, hypertension, diabetes mellitus and hypercholesterolemia. Awareness,treatment and control rates were assessed among individuals with each condition. A summary risk score (0, 1, 2, ≥3 risk factors) was constructed excluding obesity, given its causal relationship with other cardiometabolic factors. Subgroup analyses were stratified by age group (20–34, 35–49, 50–64 and ≥65 years). Results Overall, 62,064 participants (49.9% women) were included. Throughout the study period from 2013 to 2024, men consistently exhibited higher prevalence of current smoking, hypertension and elevated body mass index, whereas hypercholesterolemia was more prevalent in women (Table 1). The proportion of individuals free from all four major risk factors declined in women (58.1% to 53.0%) but increased slightly in men (33.0% to 35.2%). In 2022–2024, 35.2% of men and 53.0% of women were free from all four major risk factors; however, ≥3 concurrent risk factors were present in 9.7% of men compared with 5.2% of women. Management rates of hypertension (awareness: 51.4% to 62.2% in men, 53.8% to 61.1% in women; treatment and control: 33.1% to 48.3% in men, 37.6% to 48.2% in women) and diabetes (53.1% to 67.1% in men, 50.2% to 67.0% in women; 9.7% to 25.4% in men, 10.6% to 23.3% in women) improved substantially and were broadly comparable between sexes by 2024. In contrast, sex disparities persisted in lipid management. In 2022–2024, awareness of hypercholesterolemia was 60.2% in men and 55.2% in women, and treated and controlled hypercholesterolemia was achieved in 48.6% of men compared with 43.3% of women. The gap was most pronounced among individuals aged 50–64 years, despite broadly similar or improving lipid profiles at the population level (Figure 1). Conclusion In Korea, men carried a greater overall cardiometabolic risk burden; however, women experienced persistent gaps in lipid treatment and control, particularly during midlife. These findings underscore a sex-specific inequity in preventive cardiovascular care and highlight the need for targeted, life-course strategies to optimize risk factor management in both women and men.