Gender Differences in Major Risk Factors for Cardiovascular Disease in Mexican Adults

Lourdes Flores-Luna; Consuelo Escamilla-Núñez; Ivette Cruz-Bautista; Rosalba Rojas-Martínez; Leticia Hernández-Cadena; Lilia Castro-Porras; Martín Romero-Martínez; Carlos A. Aguilar-Salinas

doi:10.5334/gh.1531

Figures & Tables

Table 1

Sociodemographic characteristics of the adult population by sex. Mexico, Ensanut 2018.

CHARACTERISTIC	ALL	MEN	WOMEN
Sample size in adults 20 years or more	10,503	4,502	6,001
Frequency in thousand	82,767	37,551	45,216
*Sociodemographic*
Age, years (mean)	44.3 [43.6,44.9]	43.9 [43.1,44.8]	44.5 [43.7,45.4]
20–39	43.3 [41.5,45.1]	44.4 [42.0,46.9]	42.3 [39.9,44.7]
40–59	36.8 [35.2,38.4]	36.1 [33.9,38.5]	37.4 [35.3,39.6]
60 and more	19.9 [18.5,21.4]	19.4 [17.6,21.4]	20.3 [18.5,22.3]
Education level
None-education	5.4 [4.8,6.1]	4.4 [3.6,5.3]	6.3 [5.5,7.2]
Elementary school	55.3 [53.6,57.0]	53.4 [50.8,55.9]	57.0 [54.7,59.2]
High school	21.1 [19.7,22.6]	22.2 [20.0,24.5]	20.2 [18.4,22.3]
College or higher	18.1 [16.7,19.6]	20.1 [18.0,22.4]	16.5 [14.8,18.4]
Marital status
Single	21.4 [19.9,23.0]	24.3 [22.1,26.7]	18.9 [16.9,21.1]
Married or living with a partner	66.7 [65.0,68.3]	68.4 [65.9,70.7]	65.3 [63.0,67.5]
Separated, divorced, or widowed	12.0 [11.0,13.0]	7.3 [6.2,8.6]	15.8 [14.4,17.4]
Indigenous language speaker	6.2 [5.2,7.4]	6.0 [5.0,7.3]	6.3 [5.1,7.7]
Usual health insurance
IMSS	32.9 [31.1,34.7]	33.1 [30.6,35.6]	32.8 [30.6,35.1]
ISSSTE	6.0 [5.1,6.9]	5.1 [4.1,6.4]	6.6 [5.5,8.0]
SSA	33.8 [32.1,35.5]	31.5 [29.1,33.9]	35.6 [33.4,37.9]
Pharmacy-Adjacent Clinic	12.4 [11.1,13.7]	13.4 [11.5,15.7]	11.5 [10.1,13.1]
Others	15.0 [13.7,16.3]	16.9 [14.9,19.1]	13.4 [12.0,15.1]
Depressive symptomatology present	18.3 [17.1,19.5]	13.8 [12.2,15.6]	22.0 [20.4,23.8]
Socioeconomic status
Low	29.1 [27.4,30.9]	29.5 [27.2,32.0]	28.7 [26.7,30.8]
Medium	32.7 [31.1,34.4]	32.0 [29.6,34.5]	33.3 [31.2,35.5]
High	38.2 [36.2,40.2]	38.5 [35.8,41.2]	38.0 [35.5,40.6]

Table 2

Prevalence of cardiovascular risk factors and the onset of CVD in adults by sex. Mexico, Ensanut 2018.

CHARACTERISTIC	# RISK FACTOR	ALL	MEN	WOMEN
Sample size in adults 20 years or more		10,503	4,502	6,001
Frequency in thousand		82,767	37,551	45,216
*CVD RISK FACTORS*
*Overweight or obesity*
Overweight (25 ≥ BMI < 30 kg/m²)		39.6 [38.0,41.3]	42.0 [39.6,44.5]	37.7 [35.4,40.0]
Obesity (BMI ≥ 30 kg/m²)	F1	35.0 [33.4,36.6]	30.7 [28.3,33.1]	38.6 [36.5,40.7]
Central obesity IDF (WC ≥ 90 in men and ≥ 80 cm in women)		80.0 [78.7,81.3]	71.7 [69.4,73.9]	86.9 [85.3,88.4]
*Hypertension (HTA)*
Previous medical diagnosis of HTA		18.5 [17.2,19.8]	15.7 [14.0,17.5]	20.8 [19.1,22.6]
Hypertension treatment		68.4 [65.0,71.5]	61.3 [55.5,66.9]	72.8 [68.9,76.3]
Undiagnosed hypertension (140/90 mm Hg)		13.0 [11.8,14.2]	17.0 [15.3,19.0]	9.6 [8.4,11.1]
Hypertension + (Dx or Tx or 140/90 mm Hg)	F2	31.5 [29.9,33.1]	32.7 [30.5,35.1]	30.4 [28.4,32.5]
*Diabetes (T2DM)*
Previous medical diagnosis of T2DM		10.3 [9.4,11.3]	9.1 [7.9,10.4]	11.4 [10.1,12.8]
T2DM treatment		85.7 [82.4,88.5]	82.6 [77.3,87.0]	87.8 [83.2,91.2]
Undiagnosed diabetes (Glu ≥126 or HbA1c ≥ 6.5)		5.7 [5.0,6.5]	5.2 [4.2,6.4]	6.1 [5.1,7.2]
Insulin Resistance (METS-IR index ≥ 51.13)		55.0 [48.1,61.8]	46.6 [36.8,56.7]	61.0 [51.7,69.5]
Total Diabetes (Dx or Glu ≥ 126 or HbA1c ≥ 6.5)	F3	16.0 [14.9,17.2]	14.3 [12.7,16.0]	17.4 [15.8,19.1]
*Lipides, mg/dL*
Hypercholesterolemia (TC ≥ 200)		33.8 [32.1,35.6]	33.8 [31.4,36.4]	33.8 [31.7,36.1]
High LDL-C (LDL-C ≥100)		57.6 [55.6,59.6]	57.0 [54.0,60.0]	58.0 [55.5,60.5]
Low HDL-C (< 40 in men and < 50 in women)		56.1 [54.4,57.8]	42.8 [40.3,45.3]	67.2 [65.0,69.4]
Hypertriglyceridemia (TGs ≥ 150)		56.9 [55.2,58.6]	62.8 [60.4,65.1]	52.1 [49.8,54.4]
Dyslipidemia (TC ≥ 200 or LDL-C ≥ 100 or Low HDL-C)	F4	84.6 [83.3,85.8]	79.9 [77.7,81.8]	88.5 [86.9,90.0]
Remnant cholesterol ≥ 30 mg/dL		46.3 [44.4,48.3]	49.1 [46.1,52.1]	44.4 [41.9,46.9]
*Family history (father and/or mother)*
Hypertension		51.6 [49.9,53.3]	49.6 [46.9,52.3]	53.2 [51.0,55.5]
Heart attack (HA)	F5	17.7 [16.4,19.1]	15.7 [13.9,17.6]	19.5 [17.7,21.4]
Before 50 years had his/her first HA		79.8 [74.9,84.0]	80.6 [72.7,86.7]	79.4 [72.7,84.7]
*Modifiable lifestyle*
Physical activity
Vigorous and moderate		79.7 [78.3,81.0]	83.2 [81.1,85.0]	76.8 [74.8,78.6]
Inactive		20.3 [19.0,21.7]	16.8 [15.0,18.9]	23.2 [21.4,25.2]
Current smoker	F6	18.6 [17.2,20.0]	29.9 [27.5,32.3]	9.2 [7.9,10.6]
Excessive drinking^a		58.5 [55.6,61.4]	67.2 [63.9,70.4]	43.3 [38.9,47.7]
*Others*
Low-eGFR, eGFR < 60 ml/min/1.73 m		2.2 [1.8,2.6]	2.5 [1.9,3.3]	1.9 [1.4,2.5]
High CVD risk (CVD-risk estimated by Globorisk equation ≥ 10%)^b		29.4 [27.4,31.5]	38.1 [34.9,41.4]	22.4 [20.3,24.7]
*ONSET OF CVD*
*At least one diagnosed CVD event*		5.7[4.7,6.9]	5.7[4.2,7.8]	5.6[4.4,7.2]
Heart attack		2.6[2.0,3.2]	2.7[2.0,3.7]	2.4[1.7,3.4]
Angina pectoris		2.5[1.8,3.5]	3.0[1.7,5.2]	2.2[1.6,3.1]
Heart failure		2.4[1.8,3.2]	1.9[1.3,2.8]	2.7[1.8,4.2]

[i] ^aThis pattern corresponds to consuming five or more drinks (male), or four or more drinks (female), the last 30 days.

^b10-year risk estimates for individuals 40–79 years of age.

Risk factors associated with CVD in the adult population acording to CVD diagnosis and sex and age. Mexico, Ensanut 2018.
Definitions: O: Obesity, D: Dyslipidemia, HTA: Hipertensión, T2DM: Diabetes, FHH: Family history of heart attack and CS: Current smoker.
Sample size in adults 20 years or more:12,796 and frecuency in thousand 96,476.

Table 3

Adult characteristics according to pharmacological treatment. Mexico, Ensanut 2018.

THERAPEUTIC TARGET	AT LEAST ONE DIAGNOSED CVD
	ALL	TREATMENT USE^a
	ALL	WITH TREATMENT	WITHOUT TREATMENT	NOT RESPONDED
Sample size in adults 20 years or more	415	255	50	110
Frequency in thousand	2,947	1,692	452	803
*Demographics*
Sex, men	49.8 [42.0,57.6]	49.6 [40.0,59.3]	64.5 [45.9,79.6]	41.9 [27.4,57.9]
Age, years (mean)
20–39	29.8 [23.0,37.6]	15.9 [8.8,27.0]	32.6 [16.7,53.8]	57.5 [41.1,72.3]
40–59	32.7 [26.0,40.2]	34.1 [25.4,43.9]	42.5 [24.5,62.6]	24.3 [13.2,40.4]
60 and more	37.5 [30.6,44.9]	50.0 [40.4,59.6]	24.9 [12.4,43.8]	18.2 [8.4,35.1]
*Family history (father and/or mother)*
Hypertension	64.6 [56.4,72.0]	64.8 [54.7,73.8]	47.3 [27.7,67.6]	73.6 [58.1,84.9]
Heart attack (HA)	34.8 [27.6,42.7]	40.9 [31.6,50.9]	18.5 [7.7,38.3]	30.9 [17.6,48.4]
Before 50 years had his first HA	67.8 [48.1,82.7]	65.6 [40.8,84.0]	100.0	71.2 [39.2,90.4]
*Body composition*
Normal weight (18.5 ≥ BMI < 24.9 kg/m²)	16.1 [11.6,21.9]	12.6 [8.0,19.3]	23.3 [11.2,42.2]	19.6 [10.1,34.6]
Noncentral obesity (WC < 90 in men and < 80 cm in women)	10.5 [84.9,15.1]	8.8 [5.2,14.6]	8.6 [3.9,17.9]	15.3 [7.7,28.0]
Lost five kilos or more of weight in the last year	21.5 [15.3,29.2]	23.4 [15.9,33.1]	24.7 [10.6,47.5]	15.6 [6.9,31.6]
*Control*
Hypertension Arterial (systolic < 140 mmHg and diastolic < 90 mmHg)	71.6 [22.2,77.8]	68.8 [59.9,76.5]	56.6 [36.0,75.2]	86.0 [71.1,93.9]
Diabetes (80 ≥ Glu ≤ 130 mg/dL and HbA1c ≤ 7%)	73.9 [66.6,80.1]	74.1 [65.1,81.5]	80.7 [61.6,91.6]	69.6 [53.0,82.3]
Lipid control (LDL-C < 100 or HDL-C ≥ 40 in men and ≥ 50 in women)	18.8 [74.1,25.9]	14.6 [8.5,24.0]	19.7 [9.7,35.9]	27.2 [15.2,43.7]
*Lifestyle*
Ex-smoker or never smoker	80.3 [13.7,86.3]	86.1 [75.8,92.5]	88.7 [70.8,96.2]	63.4 [46.8,77.3]
Physical activity (moderate and vigorous: at least 150 minutes per week)	77.6 [16.4,83.6]	70.9 [60.0,79.8]	87.5 [69.1,95.6]	85.2 [73.6,92.3]

[i] ^aTreatment use included stains and hypertensive agents.

Table 4

Adjusted risk of having cardiovascular disease^a in the presence of a major risk factor for CVD in México, Ensanut 2018.

MODEL	RISK FACTOR	ADJUSTING FOR TREATMENT USE^b				WITHOUT ADJUSTING FOR TREATMENT USE
		MEN		WOMEN		MEN		WOMEN
		aOR [95% CI]	p VALUE	aOR [95% CI]	p VALUE	aOR [95% CI]	p VALUE	aOR [95% CI]	p VALUE
	Sample size in adults 20 years or more	3,879		5,248		3,915		5,303
	Frequency in thousand	33,361		40,506		33,623		40,927
M1x	Obese	0.7[0.4, 1.4]	0.32	1.6[0.9, 2.8]	0.09	0.8[0.5, 1.4]	0.47	1.3[0.8, 2.1]	0.22
M1x	Dyslipidemia (DLD)	1.7[0.8, 3.7]	0.16	1.4[0.6, 2.9]	0.42	1.7[0.9, 3.1]	0.10	1.1[0.7, 1.9]	0.66
M1x	Hypertension (HTA)	1.6[0.8, 3.4]	0.21	2.4[1.2, 4.8]	0.01	2.3[1.3, 4.1]	0.005	3.2[2.1, 4.8]	< 0.001
M1x	Diabetes (T2DM)	1.9[1, 3.7]	0.06	0.5[0.3, 0.9]	0.02	2.6[1.4, 4.9]	0.003	0.7[0.4, 1.2]	0.21
M1x	First-order family history of heart attack (FHH)	1.1[0.6, 2.3]	0.74	1.8[1, 3.1]	0.04	1.5[0.8, 2.8]	0.19	2.2[1.4, 3.4]	0.001
M1x	Current smoker (CS)	0.9[0.4, 2]	0.82	0.7[0.3,1.9]	0.50	1.2[0.6, 2.1]	0.61	1.8[0.8, 4.4]	0.19
M1x	Obese	0.8[0.4, 1.6]	0.55	1.9[1.1, 3.2]	0.02	1.1[0.6, 1.9]	0.76	1.7[1.1, 2.7]	0.02
M2x	Obese + DLD	0.6[0.3, 1.2]	0.14	1.9[1.1, 3.2]	0.02	0.8[0.5, 1.5]	0.55	1.7[1.1, 2.6]	0.03
M3x	Obese + DLD + HTA	0.8[0.4, 1.7]	0.57	2.6[1.5, 4.5]	0.001	1.6[0.9, 3]	0.13	3.4[2.2, 5.3]	< 0.001
M4x	Obese + DLD +HTA+T2DM	1.1[0.4, 3.4]	0.84	1.2[0.6, 2.4]	0.68	2.2[0.8, 6.3]	0.12	2.5[1.2, 5.1]	0.01
M5x	Obese + DLD +HTA+T2DM+FHH	2.6[0.5, 12.0]	0.24	1.6[0.7, 3.9]	0.30	6.1[1.5, 24.2]	0.01	4.5[1.7, 12]	0.002
M6x	Obese + DLD +HTA+T2DM+FHH+CS	22.4[4.2, 120.5]	< 0.001	1.7[0.2, 17.8]	0.67	24.3[3.2, 186.4]	0.002	2.8[0.3, 26.9]	0.38

[i] aOR: adjusted odds ratio.

All models were adjusted for age, physical activity, total energy, and socioeconomic status; additionally, the women’s model included postmenopausal status.

^aCardiovascular diseases include heart attack, angina pectoris, and heart failure.

^bTreatment use included statins and anti-hypertensive agents.

Gender Differences in Major Risk Factors for Cardiovascular Disease in Mexican Adults

Figures & Tables

Table 1

Table 2

Figure 1

Table 3

Table 4

Paradigm

My account