Related Experiment Video
Updated: Nov 9, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Sex Differences in Cardiovascular Outcomes in CKD: Findings From the CRIC Study
Stephanie M Toth-Manikowski1, Wei Yang2, Lawrence Appel3
1Department of Medicine, University of Illinois at Chicago, Chicago, IL.
Insights
In adults with chronic kidney disease (CKD), women experienced fewer cardiovascular events and lower mortality rates compared to men. These findings highlight important sex-based differences in cardiovascular risk within the CKD population.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Cardiovascular events are generally less frequent in women than men.
- However, existing research on sex-based differences in cardiovascular disease (CVD) risk among individuals with chronic kidney disease (CKD) remains inconclusive.
- This study addresses this gap by investigating sex-specific cardiovascular outcomes in a CKD cohort.
Purpose of the Study:
- To evaluate sex-related differences in the incidence of major cardiovascular events and mortality among adults diagnosed with chronic kidney disease (CKD).
- To compare the risks of atherosclerotic composite outcomes, heart failure, cardiovascular death, and all-cause mortality between women and men with CKD.
Main Methods:
- A prospective cohort study design was employed, utilizing data from 1,778 women and 2,161 men enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study.
- Cox proportional hazards regression models were used to analyze the association between sex (women vs. men) and cardiovascular outcomes over a median follow-up of 9.6 years.
- Analyses were adjusted for sociodemographic, clinical, metabolic, cardiac, and inflammation biomarkers.
Main Results:
- Over a median follow-up of 9.6 years, women exhibited a lower risk of atherosclerotic composite outcomes (HR, 0.71; 95% CI, 0.57-0.88), incident heart failure (HR, 0.76; 95% CI, 0.62-0.93), cardiovascular death (HR, 0.55; 95% CI, 0.42-0.72), and all-cause death (HR, 0.58; 95% CI, 0.49-0.69) compared to men.
- These significant associations persisted even after adjusting for a comprehensive set of covariates, including cardiac and inflammation biomarkers.
- Observed event counts included 698 atherosclerotic events, 762 heart failure events, 435 cardiovascular deaths, and 1,158 all-cause deaths.
Conclusions:
- In a large and diverse cohort of adults with CKD, women demonstrated a significantly lower risk of experiencing cardiovascular events, cardiovascular mortality, and overall mortality compared to men.
- These observed sex-based differences in cardiovascular risk were not attributable to measured traditional cardiovascular risk factors, cardiac biomarkers, or inflammation markers.
- Further research may be warranted to explore underlying biological or unmeasured factors contributing to these disparities, excluding sex hormones due to study limitations.
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.
Related Concept Videos
01:24Chronic Kidney Disease II: Clinical Manifestations
01:18Chronic Kidney Disease IV: Nursing Management
01:25Chronic Kidney Disease I: Introduction
01:28Chronic Kidney Disease III: Interprofessional Care
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...