Among 21,522 Algerian adults in a nationwide cardiometabolic screening cohort, sex-stratified analysis revealed sharply divergent risk profiles. Women (n=12,015) showed significantly higher adjusted odds for diagnosed hypertension (aOR 1.55) and dyslipidaemia (aOR 1.23), yet paradoxically lower odds of any established cardiovascular disease (aOR 0.84) and known CVD history (aOR 0.79). Men carried greater burdens of smoking (22.1% vs 0.9%), ischemic heart disease, arrhythmias, conduction abnormalities, and left ventricular dysfunction, alongside higher diastolic blood pressure and undiagnosed diabetes rates.
This preprint, not yet peer-reviewed, adds meaningful non-Western data to a research landscape dominated by European and North American cohorts. The apparent paradox — women holding worse metabolic markers yet lower CVD event rates — likely reflects the well-documented "treatment gap": women are diagnosed with hypertension and dyslipidaemia but may present with CVD later or atypically, leading to underdiagnosis of structural disease. The near-complete absence of female smokers (0.9%) in this Algerian sample reflects regional cultural norms rather than biology, complicating global comparisons.
Key limitations include the cross-sectional design, which prevents causal inference, and the screening-cohort selection bias toward health-seeking individuals. The striking sex disparity in smoking rates may confound multivariate models. Still, the dataset's size lends reasonable statistical power. Clinicians serving North African populations should recognize that women's lower CVD event burden does not indicate lower cardiometabolic vulnerability — tailored sex-conscious screening protocols are warranted.