[Comment] Behavioural risk factors and cardiovascular disease: are women at higher risk?

Previous work has reported that diabetes, smoking, and hypertension are more strongly associated with cardiovascular disease in women than in men.1,2 In The Lancet, Marjan Walli-Attaei and colleagues3 argue that studies on sex differences in cardiovascular risk factors are mainly from high-income countries and add to the literature by reporting their community-based study conducted in 21 high-income, middle-income, and low-income countries. In their analysis, Walli-Attaei and colleagues included 155?724 adults (90?934 [58·4%] women and 64?790 [41·5%] men) aged 35–70 years without a history of cardiovascular disease from the Prospective Urban Rural Epidemiological (PURE) study, who had a median follow-up of 10·1 years (IQR 8·5–12·0), and assessed the primary composite outcome of major cardiovascular events (cardiovascular disease deaths, myocardial infarction, stroke, and heart failure).