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Clinical Effectiveness Group

New evidence supports sex-specific strategies to prevent heart attack and stroke

An observational study led by a student of CEG’s Health Data in Practice doctoral training programme has found that the influence of risk factors for heart attack and stroke vary significantly between women and men. 


Following a historical under-representation of in women in health research, this new evidence will inform more effective strategies for preventing heart attack and stroke in both sexes. The findings also emphasize the need for appropriate representation of women in clinical trials.

The study observed 363,000 consenting women and men over a 12-year period, using data from UK Biobank and health records held by GPs and hospitals. Researchers analysed the relationship between risk factors and cardiovascular events (heart attack and stroke) and compared them between the sexes. For women: older age, high blood pressure and smoking were stronger drivers of heart attack and stroke compared to men, whereas low-density lipoprotein (also known as “bad” cholesterol) was a stronger driver for these events in men compared to women.

The research also considered a risk factor that has been identified more recently: low levels of ‘apolipoprotein A’ (ApoA). This is a protein that helps to process cholesterol in the body. Having higher levels of ApoA is thought to be a protective factor against heart attack and stroke, but the Queen Mary research found that this effect is more pronounced in men than in women. 

Important differences in incidence, patterns and outcomes of cardiovascular events between women and men have been described in research before, but the reasons for these differences are not fully understood. By comparing the level of influence that each risk factor holds, the new Queen Mary research will contribute important detail to inform sex-specific strategies for preventing heart attack and stroke more equitably across the population. 

The research was led by Elizabeth Remfry, a student on the CEG-led Wellcome Trust doctoral training programme: Heath Data in Practice. Applications for the September 2024 intake will open in October 2023.

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