Gender-sensitive modelling of atherosclerosis among women in Portugal, 2025-2034
Abstract
Background: Cardiovascular disease remains a leading cause of mortality among women and a major contributor to the burden of non-communicable diseases. Prevention and care pathways still insufficiently address sex- and gender-specific risk profiles. Evidence shows differences in risk factors, comorbidities, management and outcomes between women and men, supporting gender-sensitive policy modelling.
Methods: We applied the ATHEROS algorithm, a Bayesian epidemiological model of atherosclerosis, to estimate the impact of public health policies among women in Portugal (2025-2034). The model simulates 12 interventions across prevention, diagnosis, treatment and linkage to care. Three scenarios were analyzed: current, maximal and minimal implementation. Outcomes included risk factor prevalence, healthcare use and economic burden.
Results: Under current implementation, women’s risk profiles worsen by 2034 vs 2025, with hypertension (+1.8 pp), diabetes (+0.8 pp) and hypercholesterolemia (+2.7 pp), despite reduced smoking (-1.1 pp). Healthcare use increases (+1,611 hospitalizations; +10,964 emergency visits; +16,405 primary care consultations). Costs rise across all domains, including EUR63.0 million due to labor non-participation. Maximal implementation reduces smoking (-6.7 pp), sedentary behavior (-4.8 pp), diabetes (-2.7 pp), hypertension (-2.7 pp) and obesity (-2.2 pp), limiting additional hospitalizations to 841. Minimal implementation produces marked deterioration, with hypertension (+21.2 pp), hypercholesterolemia (+12.3 pp) and diabetes (+9.6 pp), alongside +2,610 hospitalizations and EUR472.6 million in non-participation costs.
Conclusions: Atherosclerosis in women is a preventable NCD burden. Policy inaction increases avoidable health and economic costs, while gender-sensitive modelling provides quantitative evidence to guide targeted prevention and more equitable cardiovascular outcomes.
Key messages: • Policy inaction increases cardiovascular risk and costs among women.
• Gender-sensitive modelling improves prevention and equity in cardiovascular health.
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BibTeX
@article{castro2026gendersensitive,
title = {{Gender-sensitive modelling of atherosclerosis among women in Portugal, 2025-2034}},
author = {M P Castro and H J Lopes and J O Mendes and D I Franco},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1105},
url = {https://doi.org/10.1093/eurpub/ckag169.1105},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Gender-sensitive modelling of atherosclerosis among women in Portugal, 2025-2034
AU - M P Castro
AU - H J Lopes
AU - J O Mendes
AU - D I Franco
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1105
UR - https://doi.org/10.1093/eurpub/ckag169.1105
AB - Background: Cardiovascular disease remains a leading cause of mortality among women and a major contributor to the burden of non-communicable diseases. Prevention and care pathways still insufficiently address sex- and gender-specific risk profiles. Evidence shows differences in risk factors, comorbidities, management and outcomes between women and men, supporting gender-sensitive policy modelling. Methods: We applied the ATHEROS algorithm, a Bayesian epidemiological model of atherosclerosis, to estimate the impact of public health policies among women in Portugal (2025-2034). The model simulates 12 interventions across prevention, diagnosis, treatment and linkage to care. Three scenarios were analyzed: current, maximal and minimal implementation. Outcomes included risk factor prevalence, healthcare use and economic burden. Results: Under current implementation, women’s risk profiles worsen by 2034 vs 2025, with hypertension (+1.8 pp), diabetes (+0.8 pp) and hypercholesterolemia (+2.7 pp), despite reduced smoking (-1.1 pp). Healthcare use increases (+1,611 hospitalizations; +10,964 emergency visits; +16,405 primary care consultations). Costs rise across all domains, including EUR63.0 million due to labor non-participation. Maximal implementation reduces smoking (-6.7 pp), sedentary behavior (-4.8 pp), diabetes (-2.7 pp), hypertension (-2.7 pp) and obesity (-2.2 pp), limiting additional hospitalizations to 841. Minimal implementation produces marked deterioration, with hypertension (+21.2 pp), hypercholesterolemia (+12.3 pp) and diabetes (+9.6 pp), alongside +2,610 hospitalizations and EUR472.6 million in non-participation costs. Conclusions: Atherosclerosis in women is a preventable NCD burden. Policy inaction increases avoidable health and economic costs, while gender-sensitive modelling provides quantitative evidence to guide targeted prevention and more equitable cardiovascular outcomes. Key messages: • Policy inaction increases cardiovascular risk and costs among women. • Gender-sensitive modelling improves prevention and equity in cardiovascular health.
SN - 1101-1262
SN - 1464-360X
ER -