Sex differences in atherosclerosis and its clinical sequelae

Several years ago, cardiovascular disease (CVD) such as heart attack or stroke was exclusively seen as mens disease and has often been overlooked in women. However, nowadays it is clear that women have CVD as often as men. The reasons for CVD may differ between women and men and ongoing research tries to understand them better. CVD is often caused by atherosclerosis, a condition where arteries are clogged with fatty substances and blood flow is diminished. To assess atherosclerosis, medical doctors examine the neck arteries using ultrasound. They can measure the thickness of two layers of the walls of these arteries. In medicine, this thickness is called carotid intima-media thickness (cIMT). The marker cIMT can be used to study differences between women and men, but measurements in a lot of people are needed to obtain reliable results. At the Clinical Epidemiology Team of the Medical University of Innsbruck, we collected data from 74 studies with 106,846 people from all over the world. This project is called the Prospective Studies of Atherosclerosis (Proof-ATHERO) consortium. The FWF has now funded a research project that addresses two specific questions. The first part will focus on different risk factors for CVD, such as age, blood pressure, and body mass index. It will look whether the relationship of these risk factors with cIMT is different between women and men. Furthermore, it will use sophisticated statistical methods to identify whether combinations of risk factors are particularly harmful. The second part of the research project will focus on the consequence of having elevated cIMT. It will compare the risk of developing CVD at different cIMT values, separately for women and men. The analysis will also take into account factors specifically relevant to women, such as information on pregnancies or menopause. Collectively, the research project will provide us with a better understanding of sex differences in atherosclerosis and the development of CVD and will therefore help optimise strategies to predict and prevent CVD in women and men.

This Hertha-Firnberg project focused on sex and gender-specific differences and similarities in atherosclerosis and its clinical sequelae, in particular cardiovascular disease. We have been working on several sub-projects focusing on various factors during the life course that are specific to women. This involved factors such as age at menarche, endometriosis, hypertensive disorders of pregnancy, breastfeeding, and age at menopause. For example, we could show that women who experience menopause earlier are at higher risk for different types of stroke. Furthermore, we demonstrated in a meta-analysis of >1 million parous women, that ever breastfeeding was associated with a lower risk of cardiovascular disease later in life. In addition to factors specific to women, we investigated sex differences and similarities in potential causal associations of well-known cardiovascular risk factors, such as smoking and diabetes mellitus, with the risk of developing cardiovascular disease. As part of the large-scale Prospective Studies of Atherosclerosis (Proof-ATHERO) project, we also collected data on factors specific to women to better understand the relationship between such factors and frequently used markers for atherosclerosis. The project resulted in ten publications. The underlying results were presented at international as well as national conferences, including invited talks and a keynote lecture. Furthermore, the project was accompanied by a research stay at the Julius Center for Health Sciences and Primary Care at the UMC Utrecht, which resulted in a sustainable fruitful collaboration on several ongoing research projects. As part of the projects, we received the Gender Medicine Award from the Medical University of Innsbruck as well as a conference award from the European Society of Cardiology.