An interdisciplinary study by eight experts at the University of Cincinnati College of Medicine revealed significant sex differences in cardiovascular outcomes in patients with kidney failure.
In a study conducted on 500,000 dialysis patients in the US, researchers found that women possess a higher risk of heart failure along with stroke than men. This study is published in the Journal of The American Heart Association.
We’re pleased to report that, to the best of our knowledge, these findings of a higher risk of cardiovascular events in women compared to men with kidney failure requiring dialysis have never before been reported in the literature,” said Silvi Shah, MD, MS, FASN, FACP, associate professor in UC’s Division of Nephrology & Hypertension, Department of Internal Medicine; principal investigator of the study.
Now for the evidence: Shah and her collaborators have several theories. One is the role of estrogen. Its protective properties decline in women undergoing dialysis, who tend to go into menopause years before their healthy counterparts. In addition, women who need dialysis usually do so later than men, Shah noted. When they started dialysis, she said, they usually got fewer hours of treatment than men.
Shah said more research is needed to explain why women in dialysis have cardiac events more frequently than men but live longer. Her team suggests that misdiagnoses or mismanaged treatments may be the reason. Shah said women need to be treated differently when it comes to their cardiac health.
It found large sex differences in cardiovascular health. She said these disparities between sexes and in care suggest a need for more personalized heart care for women. However, she also mentioned that the research found only part of what doctors need to consider when they examine a female patient’s cardiovascular health.
Shah said providers need to rethink prevention and education on heart disease and stroke. “This study highlights the essentiality of the promotion of overall heart health and healthy living in women with kidney failure and on dialysis, but not just in them.”
It also found more research needs to be done on women who are on dialysis, and, happily, that’s already in the works regarding Shah. Her study will center around trying to understand why women with kidney failure have more frequent cardiovascular events.
The data indicates that the overall cardiovascular event rate was higher in women (248 PTPY) compared to men (219 PTPY), with heart failure and stroke being more common in women. Women also experienced higher rates of heart failure (169 PTPY) and stroke (32 PTPY), while men had a slightly higher rate of acute coronary syndrome (ACS) events (49 PTPY).
Poisson regression revealed statistically significant differences between men and women across all cardiovascular event categories (P<0.0001). The adjusted hazard ratios indicated that women had a higher risk of cardiovascular events (HR 1.14), heart failure (HR 1.16), and stroke (HR 1.31) compared to men. However, women had a lower risk of cardiovascular death (HR 0.89) and all-cause death (HR 0.96), with a longer survival time. These differences remained significant in the time-to-event models and Kaplan–Meier survival analysis.
Reference: Shah S, Christianson AL, Karthikeyan Meganathan, et al. Sex Differences in Cardiovascular Outcomes in Patients with Kidney Failure. Journal of the American Heart Association. 2024;13(9). doi: https://doi.org/10.1161/jaha.123.029691
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