Gender difference in cardiovascular risk factors in the elderly with cardiovascular disease in the last stage of lifespan: The PROTEGER study

Background: It is known that the prognostic value of cardiovascular risk factors differed between men and women, but data in the elderly are very limited. Methods: We assessed cardiovascular structural and functional measurements (intima-media thickness, pulse pressure, pulse wave velocity, left atrial dimension (LAD), arrhythmia, deceleration time of transmitral early diastolic flow and left ventricular ejection fraction (LVEF)), by ultrasonography, blood pressure monitor, electrocardiography and applanation tonometry, as well as conventional cardiovascular risk factors (age, body mass index, smoke, total to high density lipoprotein (HDL) cholesterol ratio, and plasma glucose), and investigated their associations with all-cause mortality in men and women, separately, in 331 consecutive patients (87±7 years, 74.0% female) with a history of cardiovascular disease from the geriatric departments. After a mean follow-up of 378 days, 110 deaths were recorded. Results: In the full adjusted models, we found that increased LAD (hazard ratio [HR]=2.24 per 1-standard deviation [SD]; 95% confidential interval [CI]: 1.23-4.09), reduced LVEF (HR=0.60 per 1-SD; 95% CI: 0.38- 0.96), and increased total-to-HDL cholesterol ratio (HR=1.99 per 1-SD; 95% CI: 1.05-3.78) were significant predictors of all-cause mortality in men, whereas the presence of arrhythmia (HR=2.47; 95% CI: 1.28-4.78), increased plasma glucose (HR=1.32 per 1-SD; 95% CI: 1.06-1.64) and decreased body mass index (HR=0.60 per 1-SD; 95% CI: 0.44-0.83) could significantly predict all-cause mortality in women. Conclusions: Even in the last stage of lifespan, risk factors for all-cause death still differ significantly in men and women with cardiovascular disease. © 2010 Elsevier Ireland Ltd. All rights reserved.