Sex Differences in Cardiovascular Disease Risk and Associated Risk Factors among People Living with HIV in China

Background: People living with HIV (PLWH) have twice the risk of developing cardiovascular disease (CVD) compared to HIV-negative individuals, yet sex differences remain unclear. This study aimed to address this gap by examining sex differences in CVD risk among Chinese PLWH.

Methods: We analyzed data from hospitalized PLWH in the Third People’s Hospital of Shenzhen from 2017 to 2022. The 10-year CVD risk was estimated using the pooled cohort equations. Logistic regression and predicted marginal analyses were performed to assess adjusted sex differences in CVD risk factors. An exploratory segmented trend analysis based on five-year age groups was conducted to examine the relationship between age and the prevalence of high CVD risk.

Results: Among the 3020 participants, 7.7% had high CVD risk. Men living with HIV had a significantly higher predicted probability of high CVD risk compared with women (9.3% vs. 2.1%, P < 0.001). Among PLWH aged 18–49 years, men were significantly more likely to exhibit several CVD risk factors, including decreased high-density lipoprotein cholesterol (65.6% vs. 48.5%, P < 0.001), overweight/obesity (17.7% vs. 11.2%, P < 0.010), diabetes mellitus (3.0% vs. 1.2%, P < 0.026), and declined estimated glomerular filtration rate (13.8% vs. 8.4%, P < 0.005).

Conclusion: Significant sex disparities were observed in the predicted CVD risk and major risk factors. Healthcare providers should provide early and sex-responsive interventions, particularly for younger males with multiple modifiable risk factors and for females, in whom risk may rise rapidly postmenopause. These findings support the need for equitable, tailored strategies in CVD risk assessment and prevention for PLWH.