*Risk Factors for Cardiovascular Disease*

#### *Sex Differences in Long-Term Trends of Psychosocial Factors and Gender Effect on Risk… DOI: http://dx.doi.org/10.5772/intechopen.99767*

status was also important in men: divorced and widowed appeared to be more vulnerable (HR = 4.30 and HR = 4.84, respectively; p for all <0.001).

The risk of AH in men with D was high already in the first 5 years of follow-up observations, 6.7 times higher, gradually decreasing 10 and 16 years after screening, but it remained significant. In women, a significant cohort outcome was determined only 10 years after screening and was 1.7 times higher for those with depression. Multivariate analysis also identified a higher risk of AH among men rather than women: HR = 5.3 and HR = 1.4 (95%CI:1.04–1.98), respectively. As with high anxiety, women's risk was higher in the older age groups of 45–54 and of 55–64, significantly outpacing men in these categories, reaching HR = 6.9. At the same time, the mean level of education was a protective factor for women (HR = 0.56; p < 0.05). In men, everything is different. Divorced (HR = 3.0), those with primary education (HR = 5.6), and manual labour workers (HR = 2.8) with D had higher risks of AH compared with married men with higher education and higher occupational status (the white-collars, e.g., engineers and technicians, managers) (p for all <0.05).

Similarly revealing, in terms of gender differences, is a recent report by Kao W. T. et al. (2019). In this 10-year study, men with depression had a higher risk of AH than those without D [25]. In women, the results were contradictory: some risk models showed a decrease in the development of AH among women with depression; but using a model adjusted for other covariates, they showed an increased risk of AH in women, compared with individuals without D. The authors considered social factors to be among the many reasons for the higher risk of AH among men rather than women.

The maximum risk of hypertension in men with VE was recorded in the first five years from the start of the study HR = 3.2 (95% CI:1–7.3). Further, this risk decreased but remained significant by the end of the follow-up period. Women with VE had a 2-fold higher risk of AH after 5 years of observation, but after 10 years it was no longer statistically significant. In the multivariate model, the risk of AH was also higher in the male cohort HR = 2.9 (95%CI:1–7.9). In women, the social parameters (i.e. marital status, education, occupational status) and age included in the model reduced the risk to a greater extent than in men, although it remained significant, HR = 1.34 (95% CI:0.99–1.82). Age over 34 years (HR = 2.3) and primary education (HR = 1.8) were additional predictors of AH risk among women with VE. In the ARIC Study, the highest quartile of VE was also associated with lower educational attainment and higher systolic BP [20]. In men, the age limit was significantly higher (over 54 years old), but the increase in risk at this age was more than 5 times higher for people with VE as well. In addition, divorce played a significant role in the occurrence of AH in men with VE (HR = 3.3). This is probably the case when VE is a potential response to intractable problems in life and the inability to adapt to prolonged exposure to psychological stressors [26].

The risk of developing AH, during the first 5 years of follow-up, was already 2 times higher in both men and women with a low index of close contacts (ICC) as compared to those with higher indices. Among those with low social network indices (SNI), the risk of developing AH was 5.9 times higher among men and 1.8 times higher among women in the first 5 years of follow-up. The multivariate model retained a statistically significant risk of developing AH only in men with low ICC (HR = 1.2). At the same time, the marital status "unmarried" (i.e. single/divorced/ widowed) significantly increased the risk level to the limit of 7.1 times (for widowers). It should be noted that in widowed women, the risk of AH was also significant (HR = 2.7 95% CI: 1.03–7.35), although not as high as in men.

In women, there was also a tendency of an increased 2-fold risk of AH among those who had primary education (p = 0.06).

**Figure 1.**

*Gender differences in risk of an arterial hypertension incidence in a cohort aged 25–64 with anxiety traits, depression, vital exhaustion and low social support. Abbreviations: AH- arterial hypertension; CI- confidence interval; ICC – Index of close contacts; SNI – Social network index.*

The effect of low social ties on the risk of AH in the multivariate model was 1.7 times higher in men and 2.9 times higher in women. The effect of marital status "single" was statistically significant only in men, as well as heavy physical labour, which increased the risk by almost 3 times. However, the initial level of educational attainment was statistically significant for both sexes: the risk of AH was 1.4 times higher in men and 2 times higher in women with low SNI. In both sexes, age was a more significant risk factor because it had a linear effect on the risk of AH, being the maximum in the age group of 55–64, reaching HR = 8 in women.

In our study, marital status "unmarried" (divorced, single, or widowed) determined the extreme degree of social isolation in men with low ICC / SNI, which was reflected in a higher risk of AH in them, compared to the "tender gender", where marital status was not always a significant risk factor [27]. In the ELSA study (n = 8310), loneliness remained a significant predictor of cardiovascular events regardless of sociodemographic factors and social isolation; even after the inclusion of traditional RFS to the model, the association between loneliness and CVD was maintained [28].
