1. Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based observational study
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Sanne A E Peters, Mark Woodward, Fw Asselbergs, Folkert W Asselbergs, B Williams, GP McCann, R Zaal, Carinna Hockham, P Dark, S Prasad, A Aujayeb, A Mosterd, M Saxena, L Gabriel, CE Delsing, J De Sutter, R Pisters, P van der Meer, M Caputo, A Schut, P van der Harst, MT Kearney, YM Pinto, DP Ripley, RG Tieleman, J Redón, A Moriarty, P Woudstra, Marijke Linschoten, G Captur, Chahinda Ghossein, AK Al-Ali, FA Al-Muhanna, NYY Al-Windy, YA Almubarak, AN Alnafie, M Alshahrani, AM Alshehri, RL Anthonio, JM ten Berg, AJM van Boxem, N Charlotte, HGR Dorman, JT Drost, ME Emans, JB Ferreira, WH van Gilst, BE Groenemeijer, HE Haerkens-Arends, B Hedayat, DJ van der Heijden, E Hellou, RS Hermanides, JF Hermans-van Ast, MWJ van Hessen, SRB Heymans, ICC van der Horst, SH van Ierssel, LS Jewbali, HAM van Kesteren, Kietselaer BLJH, AMH Koning, PY Kopylov, AFM Kuijper, JM Kwakkel-vanErp, van der Linden MMJM, M Linschoten, GCM Linssen, Macias Ruiz R, FJH Magdelijns, Martens FMAC, MFL Meijs, P Messiaen, PS Monraats, L Montagna, PR Nierop, CEE van Ofwegen-Hanekamp, H Poorhosseini, AC Reidinga, MIA Ribeiro, R Salah, E Saneei, J Schaap, Schellings DAAM, A Shafiee, AC Shore, HJ Siebelink, M van Smeden, PC Smits, E Tessitore, P Timmermans, RA Tio, FVY Tjong, CA den Uil, EM Van Craenenbroeck, van Veen HPAA, T Veneman, DO Verschure, JK de Vries, RMA van de Wal, DJ van de Watering, ICD Westendorp, PHM Westendorp, C Weytjens, E Wierda, KW Wu, AG Zaman, and PM van derZee
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Medicine - Abstract
Objective To assess whether the risk of cardiovascular complications of covid-19 differ between the sexes and to determine whether any sex differences in risk are reduced in individuals with pre-existing cardiovascular disease.Design Registry based observational study.Setting 74 hospitals across 13 countries (eight European) participating in CAPACITY-COVID (Cardiac complicAtions in Patients With SARS Corona vIrus 2 regisTrY), from March 2020 to May 2021Participants All adults (aged ≥18 years), predominantly European, admitted to hospital with highly suspected covid-19 disease or covid-19 disease confirmed by positive laboratory test results (n=11 167 patients).Main outcome measures Any cardiovascular complication during admission to hospital. Secondary outcomes were in-hospital mortality and individual cardiovascular complications with ≥20 events for each sex. Logistic regression was used to examine sex differences in the risk of cardiovascular outcomes, overall and grouped by pre-existing cardiovascular disease.Results Of 11 167 adults (median age 68 years, 40% female participants) included, 3423 (36% of whom were female participants) had pre-existing cardiovascular disease. In both sexes, the most common cardiovascular complications were supraventricular tachycardias (4% of female participants, 6% of male participants), pulmonary embolism (3% and 5%), and heart failure (decompensated or de novo) (2% in both sexes). After adjusting for age, ethnic group, pre-existing cardiovascular disease, and risk factors for cardiovascular disease, female individuals were less likely than male individuals to have a cardiovascular complication (odds ratio 0.72, 95% confidence interval 0.64 to 0.80) or die (0.65, 0.59 to 0.72). Differences between the sexes were not modified by pre-existing cardiovascular disease; for the primary outcome, the female-to-male ratio of the odds ratio in those without, compared with those with, pre-existing cardiovascular disease was 0.84 (0.67 to 1.07).Conclusions In patients admitted to hospital for covid-19, female participants were less likely than male participants to have a cardiovascular complication. The differences between the sexes could not be attributed to the lower prevalence of pre-existing cardiovascular disease in female individuals. The reasons for this advantage in female individuals requires further research.
- Published
- 2023
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