Sex Differences in Cardiovascular Outcomes in Patients With Kidney Failure

• Published in: Journal of the American Heart Association Vol. 13; no. 9; p. e029691
• Main Authors: Shah, Silvi, Christianson, Annette L, Meganathan, Karthikeyan, Leonard, Anthony C, Crews, Deidra C, Rubinstein, Jack, Mitsnefes, Mark M, Schauer, Daniel P, Thakar, Charuhas V
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 07.05.2024; Wiley
• Subjects: Acute Coronary Syndrome - complications; Acute Coronary Syndrome - epidemiology; Acute Coronary Syndrome - mortality; Acute Coronary Syndrome - therapy; Aged; Aged, 80 and over; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; cardiovascular events; Cause of Death; death; dialysis; disparities; Female; Heart Failure - epidemiology; Heart Failure - mortality; Hospitalization - statistics & numerical data; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Male; Medicare - statistics & numerical data; Middle Aged; Original Research; Renal Dialysis; Renal Insufficiency - epidemiology; Renal Insufficiency - mortality; Retrospective Studies; Risk Assessment - methods; Risk Factors; sex; Sex Factors; Stroke - epidemiology; Stroke - mortality; Time Factors; United States - epidemiology; United States; cardiovascular events; dialysis; disparities; death; sex
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.123.029691

Cardiovascular disease is the leading cause of mortality in patients with kidney failure, and their risk of cardiovascular events is 10 to 20 times higher as compared with the general population. We evaluated 508 822 patients who initiated dialysis between January 1, 2005 and December 31, 2014 using the United States Renal Data System with linked Medicare claims. We determined hospitalization rates for cardiovascular events, defined by acute coronary syndrome, heart failure, and stroke. We examined the association of sex with outcome of cardiovascular events, cardiovascular death, and all-cause death using adjusted time-to-event models. The mean age was 70±12 years and 44.7% were women. The cardiovascular event rate was 232 per thousand person-years (95% CI, 231-233), with a higher rate in women than in men (248 per thousand person-years [95% CI, 247-250] versus 219 per thousand person-years [95% CI, 217-220]). Women had a 14% higher risk of cardiovascular events than men (hazard ratio [HR], 1.14 [95% CI, 1.13-1.16]). Women had a 16% higher risk of heart failure (HR, 1.16 [95% CI, 1.15-1.18]), a 31% higher risk of stroke (HR, 1.31 [95% CI, 1.28-1.34]), and no difference in risk of acute coronary syndrome (HR, 1.01 [95% CI, 0.99-1.03]). Women had a lower risk of cardiovascular death (HR, 0.89 [95% CI, 0.88-0.90]) and a lower risk of all-cause death than men (HR, 0.96 [95% CI, 0.95-0.97]). Among patients undergoing dialysis, women have a higher risk of cardiovascular events of heart failure and stroke than men. Women have a lower adjusted risk of cardiovascular mortality and all-cause mortality.