Sex, Gender, and Cardiovascular Health in Canadian and Austrian Populations

Can J Cardiol. 2021 Aug;37(8):1240-1247. doi: 10.1016/j.cjca.2021.03.019. Epub 2021 Mar 27.


Background: Evidence differentiating the effect of biological sex from psychosociocultural factors (gender) in different societies and its relation to cardiovascular diseases is scarce. We explored the association between sex, gender, and cardiovascular health (CVH) among Canadian (CAN) and Austrian (AT) populations.

Methods: The Canadian Community Health Survey (CCHS) (n = 63,522; 55% female) and Austrian Health Interview Survey (AT-HIS) (n = 15,771; 56% female) were analyzed in a cross-sectional survey design. The CANHEART/ATHEART index, a measure of ideal CVH composed of 6 cardiometabolic risk factors (smoking, physical activity, fruit and vegetable consumption, overweight/obesity, diabetes, and hypertension; range 0-6; higher scores reflecting better CVH) was calculated for both databases. A composite measure of psychosociocultural gender was computed for each country (range 0-1, higher score identifying characteristics traditionally ascribed to women).

Results: Median CANHEART 4 (interquartile range 3-5) and CAN gender scores 0.55 (0.49-0.60) were similar to median ATHEART 4 (3-5) and AT gender scores 0.55 (0.46-0.64). Although higher gender scores (CCHS: β = -1.33, 95% confidence interval [CI] -1.44 to -1.22; AT-HIS: β = -1.08, 95% CI -1.26 to -0.89)) were associated with worse CVH, female sex (CCHS: β = 0.35, 95% CI (0.33-0.37); AT-HIS: β = 0.60, 95% CI (0.55-0.64)) was associated with better CVH in both populations. In addition, higher gender scores were associated with increased prevalence of heart disease compared with female sex. The magnitude of this risk was higher in Austrians.

Conclusions: These results demonstrate that individuals with characteristics typically ascribed to women reported poorer cardiovascular health and higher risk of heart disease, independently from biological sex and baseline CV risk factors, in both countries. Female sex exhibited better CV health and a lower prevalence of heart disease than male in both populations. However, gender factors and magnitude of gender impact varied by country.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Austria / epidemiology
  • Canada / epidemiology
  • Cardiovascular Diseases / epidemiology*
  • Cross-Sectional Studies
  • Diabetes Mellitus / epidemiology
  • Diet
  • Female
  • Fruit
  • Health Status*
  • Humans
  • Hypertension / epidemiology
  • Male
  • Middle Aged
  • Overweight / epidemiology
  • Sex Distribution
  • Smoking / epidemiology
  • Surveys and Questionnaires
  • Vegetables