73 Risk factor clustering by sex in the Southern Cone of Latin America 3 To our knowledge, our study was the first to describe RF clustering in secondary prevention of CHD in the Southern Cone of Latin America. In our study of the burden of multiple RF, we studied the number of RF but also the RF type and the nature of the combinations by sex and educational attainment, which may facilitate planning of prevention strategies. The limitations of our study relate to the self-reported nature of the information on CHD diagnosis, and the size of the study especially with regard to higher educational level. Larger studies may be able study sex and socioeconomic disparities relating to the burden of multiple RF in more depth. In our study women with CHD showed a higher burden of multiple cardiovascular RF than men. Potential causes of these differences (RF awareness, medication adherence or cardiac rehabilitation attendance) were beyond this analysis, but should be addressed in future studies. CONCLUSION In the CESCAS study women had a higher burden of multiple cardiovascular RF. Cardiometabolic RF were more common than lifestyle RF, and showed a higher burden in women. Women with low educational attainment had the highest burden of multiple cardiovascular RF. Future studies should research the drivers of the higher burden cardiometabolic RF in women. Strategies and interventions for secondary prevention of CHD addressing multiple RF should be specific to sex and socioeconomic circumstances. ACKNOWLEDGMENTS The authors are very grateful for the contributions and efforts of all the CESCAS Study staff and participants. FUNDING This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) grant number HHSN268200900029C. CONFLICT OF INTEREST The authors declare no conflicts of interest.
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