63 Risk factor clustering by sex in the Southern Cone of Latin America 3 as drink-equivalents containing 14 grams of alcohol (22). Low physical activity was defined as <600 MET-minutes/week of total physical activity (23), and low consumption of fruit and vegetables was defined as <5 servings per day (< 400g per day) (14). Educational level was categorized by the highest level attained: primary, secondary or university (24). We assessed RF clustering as counts and combinations of RF. RF count was determined as the number of cardiovascular RF each participant presented, ranging from zero to eight. Combinations of factors were treated as dichotomous variables and were defined as the simultaneous presence of each combination of 3 RF (among subjects with 3 RF), and of each combination of 4 RF (among subjects with ≥4 RF ). We included 4 cardiometabolic (hypertension, dyslipidemia, diabetes and obesity or central obesity) and 4 lifestyle (current cigarette smoking, excessive alcohol consumption, low physical activity and unhealthy diet) RF for this analysis. Categorical variables were presented as number of participants and percentage, and numerical variables as mean and standard error (SE). Age-adjusted RF prevalence estimates were calculated with the overall 2010 population distribution in the Southern Cone of Latin America as reference population (14). Differences in the count of RF between men and women were tested in univariable analysis using t-test, and in a multivariable analysis adjusted by age with a Poisson regression model. Statistical significance was considered if p<0.05. Furthermore, we performed subgroup analysis to explore sex differences in RF counts and combinations within educational levels. All analyses were conducted with the statistical software RStudio (25) and the R package “survey” (26). RESULTS There were 7524 respondents from the 10554 randomly invited participants. Across the 4 study locations the response rate (73.4%) was similar in men and women. The prevalence of established CHD was 8.4% in the overall study population, 10.0% in men and 7.3% in women (634 participants with CHD). Half of the participants with CHD were women, and mean age was 60.0 years (standard error 9.8 years). More than half of the participants completed primary school, 33.6% achieved secondary schooling, and 12.3% had a tertiary level or university degree. The most common presentation of CHD was angina, followed by myocardial infarction and history of coronary procedures, which were significantly more common in men (Table 1). The prevalence of cardiometabolic RF ranged from 76.3% (hypertension) to 26.8% (diabetes), and the prevalence of lifestyle RF varied from 81.9% (unhealthy diet) to 4.3% (excessive alcohol consumption). Cardiometabolic RF as obesity, central obesity and low physical activity were more common in women, while the behavioral RF as smoking, alcohol consumption, and unhealthy diets were more prevalent in men (Table 1). RF prevalence by sex and educational level is presented in Figure 1A.
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