61 Risk factor clustering by sex in the Southern Cone of Latin America 3 INTRODUCTION There are relevant differences in coronary heart disease burden, mortality, and treatment between men and women (1). Sex differences exist also in cardiovascular risk factors (RF): some RF such as smoking and hypertension are reported to be more common in men, while obesity and diabetes are more prevalent in women (2–4). Cardiovascular RF tend to cluster in individuals, and the presence of multiple RF increases the risk of cardiovascular disease more than the added risks of individual RF (5). Studies from different world regions, studying the presence from 4 to 12 cardiovascular RF, show that the prevalence of multiple cardiovascular RF is high and ranges from 45.2% to 99.9% in men and 24.6% to 99.8% in women (4–8), although these estimates depend on how many and which RF are included in the analysis. The evidence on sex differences in RF clustering shows diverging results, with studies finding a higher burden of multiple RF in women (7,9) and others in men (4,5,8). Generally, these clusters are composed of various RF combined with obesity and diabetes in women, and smoking in men (7,10). Socioeconomic status is also known to influence the presentation of multiple cardiovascular RF, with people with lower educational attainment being more prone to present with multiple cardiovascular RF (11). Besides, the magnitude and direction of sex differences in the burden of multiple cardiovascular RF can vary by socioeconomic status (11,12). Information about RF clustering in coronary heart disease (CHD) patients is scarce but it shows that prevalence of multiple RF is very high in CHD patients, especially in men (2). Since this population is at very high cardiovascular risk (13), a better understanding of clustering of CVD RF in men and women with CHD will contribute to the development of effective secondary prevention strategies. Within the South American region, available studies reporting on RF clustering are limited (6,14,15). The Centro de Excelencia en Salud Cardiovascular para el Cono Sur (CESCAS) study aims to research C RF and CVD in 4 cities in the Southern Cone of Latin America (3). More than two thirds of the CESCAS overall study population presented with ≥ 3 cardiovascular RF, and more women than men had ≥ 5 (14). Nevertheless, information about RF clustering in South American men and women with established CHD is currently not available. The current study aims to investigate differences in the distribution of multiple RF between men and women with established CHD in the southern Cone of Latin America, within CESCAS Study. In addition, we plan to describe potential sex differences in RF clustering across educational levels. METHODS The CESCAS study is a population-based cohort including 7524 participants aged 35-74 years. The details of the study design and sampling methods have been described previously (3). Shortly, urban and rural participants were recruited from randomly selected samples between February 2010 and December 2011 in 4 medium-size cities in the Southern Cone of Latin America: Bariloche and Marcos Paz (Argentina), Temuco (Chile) and Pando-Barros Blancos (Uruguay). The baseline cross-sectional data obtained in the first phase of CESCAS was used for this analysis. For this study, we focus on the 634 participants with a diagnosis of CHD. The study was conducted following the guidelines for protection of human volunteers’ rights and it is in compliance with the Declaration of Helsinki. The protocol of the study received
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