Sex Differences in the Assessment of Cardiovascular Risk in Primary Health Care: A Systematic Review

Karice K Hyun*, Elizabeth R C Millett, Julie Redfern, David Brieger, Sanne A E Peters, Mark Woodward

*Corresponding author for this work

Research output: Contribution to journalReview articleResearchpeer-review

8 Citations (Scopus)


OBJECTIVE: To determine whether sex differences exist in the assessment of cardiovascular disease (CVD) risk scores/risk factors in primary health care.

DESIGN/METHODS: PubMed and EMBASE were systematically searched on 31 January 2017. Clinical trials and observational studies were included if they reported on the assessment of CVD risk score, blood pressure (BP), cholesterol or smoking status in primary health care, stratified by sex. Meta-analyses were performed, using random effects models, to determine differences between sexes, separately for adjusted and unadjusted data.

RESULTS: Of 14,928 studies found in the search, 22 studies (including 4,754,782 patients) were included in the systematic review with the meta-analysis for quantitative assessment. Overall, the assessment rates of CVD risk score and risk factors were similar in women and men (CVD risk score: 30.7% vs. 35.2% [difference (95% CI): -4.5 (-5.1, -3.9)]; BP: 91.3% vs. 88.5% [2.8 (2.5, 3.0)]; cholesterol: 69.9% vs. 71.0% [-1.1 (-1.5, -0.8)]; and smoking: 85.9% vs. 86.7% [-0.8 (-1.1, -0.5)]). The pooled, adjusted likelihood of having the risk score, BP and cholesterol assessments were comparable between women and men: OR (95% CI): 0.87 (0.70, 1.07); 1.41 (0.89, 2.25); and 1.15 (0.82, 1.60), respectively. However, women were 32% less likely to be assessed for smoking (0.68 [0.47, 1.00]). There was substantial heterogeneity between studies and the risk of publication bias was moderate.

CONCLUSION: Despite the guideline recommendations, assessment of CVD risk score in primary health care was low in both sexes. Further, women were less likely to be assessed for their smoking status than men, whereas no sex discrepancies were found for BP and cholesterol assessments.

Original languageEnglish
Pages (from-to)1535-1548
Number of pages14
JournalHeart Lung and Circulation
Issue number10
Publication statusPublished - Oct 2019
Externally publishedYes


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