TY  - JOUR
A1  - George, J
A1  - Rapsomaniki, E
A1  - Pujades-Rodriguez, M
A1  - Shah, AD
A1  - Denaxas, S
A1  - Herrett, E
A1  - Smeeth, L
A1  - Timmis, A
A1  - Hemingway, H
N2  - BACKGROUND: Given the recent declines in heart attack and stroke incidence, it is unclear how women and men differ in first lifetime presentations of cardiovascular diseases (CVDs). We compared the incidence of 12 cardiac, cerebrovascular, and peripheral vascular diseases in women and men at different ages. METHODS AND RESULTS: We studied 1 937 360 people, aged ? 30 years and free from diagnosed CVD at baseline (51% women), using linked electronic health records covering primary care, hospital admissions, acute coronary syndrome registry, and mortality (Cardiovascular Research Using LInked Bespoke Studies and Electronic Records [CALIBER] research platform). During 6 years median follow-up between 1997 and 2010, 114 859 people experienced an incident cardiovascular diagnosis, the majority (66%) of which were neither myocardial infarction nor ischemic stroke. Associations of male sex with initial diagnoses of CVD, however, varied from strong (age-adjusted hazard ratios, 3.6-5.0) for abdominal aortic aneurysm, myocardial infarction, and unheralded coronary death (particularly >60 years), through modest (hazard ratio, 1.5-2.0) for stable angina, ischemic stroke, peripheral arterial disease, heart failure, and cardiac arrest, to weak (hazard ratio <1.5) for transient ischemic attack, intracerebral hemorrhage, and unstable angina, and inverse (0.69) for subarachnoid hemorrhage (all P<0.001). CONCLUSIONS: The majority of initial presentations of CVD are neither myocardial infarction nor ischemic stroke, yet most primary prevention studies focus on these presentations. Sex has differing associations with different CVDs, with implications for risk prediction and management strategies. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01164371.
JF  - Circulation
UR  - http://dx.doi.org/10.1161/CIRCULATIONAHA.114.013797
KW  - aging
KW  -  cardiovascular diseases
KW  -  electronic health records
KW  -  incidence
KW  -  population
KW  -  risk factors
KW  -  sex
ID  - discovery1471597
AV  - public
TI  - How Does Cardiovascular Disease First Present in Women and Men? Incidence of 12 Cardiovascular Diseases in a Contemporary Cohort of 1,937,360 People.
SP  - 1320
Y1  - 2015/10/06/
EP  - 1328
N1  - © 2015 The Authors.
Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.
VL  - 132
SN  - 1524-4539
IS  - 14
ER  -