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American Journal of Kidney Diseases

Sex Differences in Cardiovascular Outcomes in CKD: Findings From the CRIC Study

Published:April 12, 2021DOI:https://doi.org/10.1053/j.ajkd.2021.01.020

      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.

      Graphical abstract

      Index Words

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