CHICAGO (FRONTLINE MEDICAL NEWS)Two out of three 55-year-old men and women will develop some form of cardiovascular disease during their remaining lifetime, but the first manifestation differs considerably by gender, according to a new analysis from The Rotterdam Study.

In men, the first manifestation of cardiovascular disease is most often a coronary heart disease event. Women are more likely to experience cerebrovascular disease or heart failure as their first event, Dr. Maarten J.G. Leening reported at the American Heart Association scientific sessions. Simultaneously with his presentation, the findings were published online in BMJ.

This new finding has important implications for primary prevention, noted Dr. Leening of Erasmus University, Rotterdam.

“Most of the attention of late in primary prevention has been drawn to the 2013 [AHA/ACC] lipid guidelines. But as we can see, for women it’s heart failure and cerebrovascular disease that are the major contributors to overall risk. And we know from the statin trials that there is no or only very limited reduction in heart failure and that the risk reduction for cerebrovascular disease is much smaller than for CHD. So our findings highlight the importance of blood pressure control and lifestyle factors, especially smoking, for primary prevention in women, since those are the best-established risk factors for cerebrovascular disease and heart failure,” he said.

Dr. Leening reported on 8,419 participants of The Rotterdam Study aged 55 or older, all free from cardiovascular disease at baseline. During a median 13.5 years and up to 20 years of follow-up in this ongoing prospective population-based study, 2,888 subjects developed cardiovascular disease. Coronary heart disease accounted for 826 of these first events, cerebrovascular events accounted for another 1,198, heart failure 726, and there were 102 other cardiovascular deaths.

At age 55, the overall lifetime risk of developing cardiovascular disease was 67.1% in men and 66.4% in women, although these rates slightly underestimate the true risks because data on peripheral arterial disease, nonfatal aortic aneurysms, and angina managed exclusively medically weren’t collected.

This is the first study to scrutinize gender differences in the first manifestations of cardiovascular disease, broadly defined. For purposes of primary prevention, the first manifestation of cardiovascular disease is what’s most relevant, not the final fatal one, he noted.

From an absolute risk perspective, CHD as the first manifestation of cardiovascular disease clearly stood out as the major difference between men and women. In a comparison of 1,000 women with an equal number of men, there were 102 fewer cases of CHD in the women. This was offset by 70 more cases of cerebrovascular disease and 26 additional cases of heart failure in the women.

It’s particularly noteworthy that heart failure accounted for one-quarter of the first manifestations of cardiovascular disease in women, given that by definition none of the cases of heart failure recorded in this study were preceded by CHD. This underscores the importance of focusing of risk factors other than dyslipidemia, the physician said.

The Netherlands Organization for Health Research and Development and a variety of Dutch foundations funded the study. Dr. Leening reported having no financial conflicts of interest.