Sex-Related Disparities in Cardiometabolic Burden Among a Large Algerian Cohort

Background: Cardiovascular diseases (CVD) are the leading cause of mortality worldwide. Historically, male sex was considered a cardiovascular risk factor however recent accumulating data suggest complex interaction between sex and CVD leading to specific inequalities affecting both males and females with specific cardiometabolic features. Methods: Data from a large nationwide screening cohort were used to assess the cardiometabolic burden among males vs females in Algeria. The prevalence and adjusted Odds Ratio (aOR) of major CVD diseases were compared across the study cohorts. Records of systolic (SBP) and diastolic blood pressure (DBP), as well as findings of clinical examination, ECG, and echocardiography were collected and reviewed for analysis. Results: A total of 21,522 patients were included among them 12,015 were females and 9,507 were males. The latter group had higher age (median age: 60 [51.00-68.00] vs 57 [49.00-65.00] years; p< 0.001), sitting DBP (83 [76.00-92.00] vs 80 [75.00-90.00]; p< 0.001), standing SBP (142 [130.00-160.00] vs 140 [124.00-154.00] mmHg; p< 0.001), smoking (22.1% vs 0.9%; p<0.001) and unknown diabetes (15.2% vs 13.2%; p< 0.001) rates. Moreover, females showed an overall worse cardiometabolic profile while males had a greater burden of ischemic heart disease, arrhythmia, conduction abnormalities, and left ventricular dysfunction. On multivariate analysis, female sex was correlated with higher aOR for known hypertension (aOR:1.55; 95%CI:1.40-1.72; p<0.001) and known dyslipidaemia (aOR: 1.23; 95%CI:1.09-1.39; p=0.001). On the other hand, female sex predicted lower risk of any CVD (aOR:0.84; 95%CI:0.72-0.98; p=0.028) and known cardiovascular disease (aOR: 0.79; 95%CI: 0.67-0.94; p=0.007). Conclusion: CVD affect males and females differently which reflects multifaceted biological, cardiometabolic, and sociodemographic disparities. These findings highlight the need to reduce the sex gap in the prevention and management of CVD. Keywords: Cardiovascular disease; Sex; Management disparities; Sex Gap; North Africa; Algeria