Department of Medicine, University of Illinois at Chicago, Chicago, IL.
Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, Philadelphia, PA.
Am J Kidney Dis. 2021 Aug;78(2):200-209.e1. doi: 10.1053/j.ajkd.2021.01.020. Epub 2021 Apr 20.
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.
Prospective cohort study.
SETTING & PARTICIPANTS: 1,778 women and 2,161 men enrolled in the Chronic Renal Insufficiency Cohort (CRIC).
Sex (women vs men).
Atherosclerotic composite outcome (myocardial infarction, stroke, or peripheral artery disease), incident heart failure, cardiovascular death, and all-cause death.
Cox proportional hazards regression.
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.
Assessment of sex hormones, which may play a role in cardiovascular risk, was not included.
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.
一般人群中女性心血管事件的发生率低于男性；然而，慢性肾脏病（CKD）相关研究的结论并不一致。本研究旨在评估 CKD 成人患者中与性别相关的心血管事件和死亡差异。
前瞻性队列研究。
共纳入慢性肾功能不全队列研究（CRIC）中的 1778 名女性和 2161 名男性。
性别（女性与男性）。
动脉粥样硬化复合结局（心肌梗死、卒中和外周动脉疾病）、新发心力衰竭、心血管死亡和全因死亡。
Cox 比例风险回归。
中位随访 9.6 年后，我们观察到 698 例动脉粥样硬化事件（女性 264 例，男性 434 例）、762 例心力衰竭事件（女性 331 例，男性 431 例）、435 例心血管死亡事件（女性 163 例，男性 274 例）和 1158 例全因死亡事件（女性 449 例，男性 709 例）。在校正社会人口学、临床和代谢参数后，女性发生动脉粥样硬化事件（HR，0.71 [95%CI，0.57-0.88]）、心力衰竭（HR，0.76 [95%CI，0.62-0.93]）、心血管死亡（HR，0.55 [95%CI，0.42-0.72]）和全因死亡（HR，0.58 [95%CI，0.49-0.69]）的风险均低于男性。这些相关性在调整心脏和炎症生物标志物后仍具有统计学意义。
未评估可能影响心血管风险的性激素。
在一个大型、多样化的 CKD 成人队列中，与男性相比，女性发生心血管事件、心血管死亡率和全因死亡率的风险较低。这些差异不能用已测量的心血管危险因素来解释。
