Journal
AMERICAN JOURNAL OF KIDNEY DISEASES
Volume 78, Issue 2, Pages 200-209Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.ajkd.2021.01.020
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Funding
- National Institute of Diabetes and Digestive and Kidney Diseases [U01DK060990, U01DK060984, U01DK0 61022, U01DK0 61021, U01DK0 61028, U01DK060980, U01DK0609 63, U01DK0609 02, U24DK060990]
- Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award NIH/NCATS [UL1TR000003]
- Johns Hopkins University [UL1 TR-000 424]
- University of Maryland [GCRC M01 RR-165 00]
- National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health [UL1TR000439]
- NIH roadmap for Medical Research
- Michigan Institute for Clinical and Health Research (MICHR) [UL1TR000433]
- University of Illinois at Chicago CTSA [UL1RR029879]
- Tulane COBRE for Clinical and Translational Research in Cardiometabolic Diseases [P20 GM109036]
- Kaiser Permanente NIH/NCRR UCSF-CTSI [UL1 RR-024131]
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM [R01DK11919 9]
- NIDDK [R01DK118736, 3R01DK072231-13S1, K24DK092290, R01DK072231-91]
- NHLBI [R01HL127028]
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In a large, diverse cohort of adults with CKD, women had lower risks of cardiovascular events, cardiovascular mortality, and mortality from any cause compared to men. These differences were not explained by measured cardiovascular risk factors.
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]1 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.
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