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Original research
Prospective analysis of gender-related characteristics in relation to cardiovascular disease
  1. Renee Bolijn1,
  2. Anton E Kunst1,
  3. Yolande Appelman2,
  4. Henrike Galenkamp1,
  5. Eric P Moll van Charante1,3,
  6. Karien Stronks1,
  7. Hanno L Tan4,5,
  8. Irene GM van Valkengoed1
  1. 1 Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
  2. 2 Cardiology, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
  3. 3 General Practice, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
  4. 4 Cardiology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
  5. 5 Netherlands Heart Institute, Utrecht, The Netherlands
  1. Correspondence to Renee Bolijn, Public and Occupational Health, Amsterdam UMC Location AMC, Amsterdam 1105 AZ, North Holland, The Netherlands; r.bolijn{at}amsterdamumc.nl

Abstract

Objective Differences in cardiovascular disease (CVD) incidence between men and women have been widely reported. Next to sex-related (biological) characteristics, gender-related (sociocultural) characteristics may partly explain how these differences arise. In this exploratory study, we examined the associations between selected gender-related characteristics and CVD incidence.

Methods We linked baseline data of 18 058 participants without CVD from the population-based, multiethnic HEalthy LIfe in an Urban Setting study (Amsterdam, the Netherlands) to CVD incidence data, based on hospital admission and death records from Statistics Netherlands in 2013–2018. Using Cox regression analyses, we studied associations of time spent on household work, doing home repairs, primary earner status, type of employment, working in a male-dominated or female-dominated occupation and desire for emotional support with CVD incidence, stratified by sex. Analyses were adjusted for age, ethnicity and socioeconomic status.

Results In men, gender-related characteristics were not associated with higher CVD incidence. In women, homemakers had a higher hazard for CVD compared with full-time workers (HR 2.34, 95% CI 1.35 to 4.04), whereas those spending a moderate amount of time on household work had a lower hazard for CVD than those spending little time (HR 0.56, 95% CI 0.34 to 0.95).

Conclusion Although we found no evidence for associations between gender-related characteristics and CVD incidence in men, being the homemaker and moderate time spent on household work appeared to be associated with CVD incidence in women. Thus, attention to gender-related characteristics might in future help to identify subgroups that may benefit from additional prevention strategies.

  • epidemiology
  • risk factors
  • coronary artery disease
  • heart failure
  • stroke

Data availability statement

Data may be obtained from a third party and are not publicly available. The HELIUS data are owned by the Academic Medical Center (AMC) in Amsterdam, the Netherlands. Any researcher can request the data by submitting a proposal to the HELIUS Executive Board as outlined at http://www.heliusstudy.nl/en/researchers/collaboration. Requests for further information and proposals can be submitted to the scientific coordinator and data manager of HELIUS, at info@heliusstudie.nl. The HELIUS Executive Board will check proposals for compatibility with the general objectives, ethical approvals and informed consent forms of the HELIUS study, and potential overlap with ongoing work affiliated with HELIUS. There are no other restrictions to obtaining the data and all data requests will be processed in the same manner.

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Data availability statement

Data may be obtained from a third party and are not publicly available. The HELIUS data are owned by the Academic Medical Center (AMC) in Amsterdam, the Netherlands. Any researcher can request the data by submitting a proposal to the HELIUS Executive Board as outlined at http://www.heliusstudy.nl/en/researchers/collaboration. Requests for further information and proposals can be submitted to the scientific coordinator and data manager of HELIUS, at info@heliusstudie.nl. The HELIUS Executive Board will check proposals for compatibility with the general objectives, ethical approvals and informed consent forms of the HELIUS study, and potential overlap with ongoing work affiliated with HELIUS. There are no other restrictions to obtaining the data and all data requests will be processed in the same manner.

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Footnotes

  • Presented at This study was presented as an abstract at 'ESC Congress 2021—The Digital Experience’ (27 August–30 August 2021).

  • Contributors RB and IGMvV contributed to the conception and design of the work. AEK and HLT contributed to the design. HG and KS contributed to the acquisition of the data. RB contributed to the analyses. All authors contributed to the interpretation of the results. RB drafted the manuscript. AEK, YA, HG, EPMvC, KS, HLT and IGMvV critically revised the manuscript. All authors gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy. RB and IGMvV are the guarantors of the work.

  • Funding The HELIUS study is conducted by the Amsterdam University Medical Centers, location AMC, and the Public Health Service of Amsterdam. Both organisations provided core support for HELIUS. The HELIUS study is also funded by the Dutch Heart Foundation, the Netherlands Organization for Health Research and Development (ZonMw), European Union (FP-7) and the European Fund for the Integration of non-EU immigrants (EIF). The work of RB and IGMvV was supported by the ZonMw Gender and Health (grant number 849200008) and Gender and Prevention (grant number 555003016) programmes. HLT has received funding from the European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET (grant number 733381), and the COST Action PARQ (grant agreement number CA19137) supported by COST (European Cooperation in Science and Technology).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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