Sex, Gender Factors and Cardiovascular Health in Canadian and Austrian Populations.

BACKGROUNDS Evidence differentiating the effect of biological sex from psycho-socio-cultural factors (gender) in different societies and its relation to cardiovascular diseases is scarce. We explored the association between sex, gender, and cardiovascular health (CVH) amongst Canadian (CAN) and Austrian (AT) populations. METHODS Canadian Community Health Survey (CCHS) (n=63,522, 55% Females) and Austrian Health Interview Survey (AT-HIS) (n=15,771, 56% Females), were analyzed in a cross-sectional, survey design study. CANHEART index, a measure of ideal CVH composed of 6 cardiometabolic risk factors (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes and hypertension; range: 0-6; higher scores reflecting ideal CVH) was calculated for both databases. A composite measure of psycho-socio-cultural gender was computed for each country (range=0-1, higher score identifying characteristics traditionally ascribed to women). RESULTS Median CANHEART 4 [3-5] and CAN gender scores 0.55 [0.49-0.60] were similar to median ATHEART 4 [3-5] and AT gender scores 0.55 [0.46-0.64]. Although higher gender scores (CCHS: β=-1.33, 95%CI (-1.44,-1.22); AT-HIS: β=-1.08, 95%CI (-1.26,-0.89)) were associated with worse CVH; female sex (CCHS: β=0.35, 95% CI (0.33,0.37); AT-HIS: β=0.60, 95%CI (0.55,0.64)) was associated with better CVH in both populations. Additionally, higher gender scores were associated with increased prevalence of heart disease, compared to female sex. The magnitude of this risk was higher in Austrians. CONCLUSIONS Our results demonstrate that individuals with characteristics typically ascribed to women, reported poorer cardiovascular health and higher risk of heart disease, independent of biological sex and baseline CV risk factors in both countries. Female sex exhibited better CV health and a lower prevalence of heart disease than males in both populations. However, gender factors and magnitude of gender impact varied by country.