TY - JOUR
T1 - Sex Differences in Cardiovascular Outcomes in CKD
T2 - Findings From the CRIC Study
AU - Chronic Renal Insufficiency Cohort (CRIC) Study Investigators
AU - Toth-Manikowski, Stephanie M.
AU - Yang, Wei
AU - Appel, Lawrence
AU - Chen, Jing
AU - Deo, Rajat
AU - Frydrych, Anne
AU - Krousel-Wood, Marie
AU - Rahman, Mahboob
AU - Rosas, Sylvia E.
AU - Sha, Daohang
AU - Wright, Jackson
AU - Daviglus, Martha L.
AU - Go, Alan S.
AU - Lash, James P.
AU - Ricardo, Ana C.
AU - Feldman, Harold I.
AU - He, Jiang
AU - Nelson, Robert G.
AU - Rao, Panduranga S.
AU - Shah, Vallabh O.
AU - Townsend, Raymond R.
AU - Unruh, Mark L.
N1 - Publisher Copyright:
© 2021 National Kidney Foundation, Inc.
PY - 2021/8
Y1 - 2021/8
N2 - Rationale & Objective: Cardiovascular events are less common in women than men in general populations; however, studies in chronic kidney disease (CKD) are less conclusive. We evaluated sex-related differences in cardiovascular events and death in adults with CKD. Study Design: Prospective cohort study. Setting & Participants: 1,778 women and 2,161 men enrolled in the Chronic Renal Insufficiency Cohort (CRIC). Exposure: Sex (women vs men). Outcome: Atherosclerotic composite outcome (myocardial infarction, stroke, or peripheral artery disease), incident heart failure, cardiovascular death, and all-cause death. Analytical Approach: Cox proportional hazards regression. Results: During a median follow-up period of 9.6 years, we observed 698 atherosclerotic events (women, 264; men, 434), 762 heart failure events (women, 331; men, 431), 435 cardiovascular deaths (women, 163; men, 274), and 1,158 deaths from any cause (women, 449; men, 709). In analyses adjusted for sociodemographic, clinical, and metabolic parameters, women had a lower risk of atherosclerotic events (HR, 0.71 [95% CI, 0.57-0.88]), heart failure (HR, 0.76 [95% CI, 0.62-0.93]), cardiovascular death (HR, 0.55 [95% CI, 0.42-0.72]), and death from any cause (HR, 0.58 [95% CI, 0.49-0.69]) compared with men. These associations remained statistically significant after adjusting for cardiac and inflammation biomarkers. Limitations: Assessment of sex hormones, which may play a role in cardiovascular risk, was not included. Conclusions: In a large, diverse cohort of adults with CKD, compared with men, women had lower risks of cardiovascular events, cardiovascular mortality, and mortality from any cause. These differences were not explained by measured cardiovascular risk factors.
AB - Rationale & Objective: Cardiovascular events are less common in women than men in general populations; however, studies in chronic kidney disease (CKD) are less conclusive. We evaluated sex-related differences in cardiovascular events and death in adults with CKD. Study Design: Prospective cohort study. Setting & Participants: 1,778 women and 2,161 men enrolled in the Chronic Renal Insufficiency Cohort (CRIC). Exposure: Sex (women vs men). Outcome: Atherosclerotic composite outcome (myocardial infarction, stroke, or peripheral artery disease), incident heart failure, cardiovascular death, and all-cause death. Analytical Approach: Cox proportional hazards regression. Results: During a median follow-up period of 9.6 years, we observed 698 atherosclerotic events (women, 264; men, 434), 762 heart failure events (women, 331; men, 431), 435 cardiovascular deaths (women, 163; men, 274), and 1,158 deaths from any cause (women, 449; men, 709). In analyses adjusted for sociodemographic, clinical, and metabolic parameters, women had a lower risk of atherosclerotic events (HR, 0.71 [95% CI, 0.57-0.88]), heart failure (HR, 0.76 [95% CI, 0.62-0.93]), cardiovascular death (HR, 0.55 [95% CI, 0.42-0.72]), and death from any cause (HR, 0.58 [95% CI, 0.49-0.69]) compared with men. These associations remained statistically significant after adjusting for cardiac and inflammation biomarkers. Limitations: Assessment of sex hormones, which may play a role in cardiovascular risk, was not included. Conclusions: In a large, diverse cohort of adults with CKD, compared with men, women had lower risks of cardiovascular events, cardiovascular mortality, and mortality from any cause. These differences were not explained by measured cardiovascular risk factors.
KW - Atherosclerotic event
KW - cardiac biomarker
KW - cardiovascular disease (CVD)
KW - cardiovascular outcomes
KW - chronic kidney disease (CKD)
KW - female
KW - heart failure
KW - male
KW - mortality
KW - myocardial infarction (MI)
KW - risk assessment
KW - sex differences
KW - sex factors
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U2 - 10.1053/j.ajkd.2021.01.020
DO - 10.1053/j.ajkd.2021.01.020
M3 - Article
C2 - 33857532
AN - SCOPUS:85106368984
SN - 0272-6386
VL - 78
SP - 200-209.e1
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -