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Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based
Carinna Hockham1,2, Marijke Linschoten3, Folkert W Asselbergs4,5
1The George Institute for Global Health, Imperial College London, London, UK.
Insights
Female patients hospitalized with COVID-19 experienced fewer cardiovascular complications than males. This protective effect in women was observed regardless of pre-existing cardiovascular disease and warrants further investigation.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- COVID-19 (Coronavirus Disease 2019) is associated with significant cardiovascular complications.
- Understanding sex-based differences in COVID-19 outcomes is crucial for personalized medicine.
Purpose of the Study:
- To investigate potential sex differences in the risk of cardiovascular complications following COVID-19 hospitalization.
- To determine if pre-existing cardiovascular disease modifies these sex-based risk differences.
Main Methods:
- A registry-based observational study (CAPACITY-COVID) involving 11,167 adult patients across 74 hospitals in 13 countries.
- Data collected from March 2020 to May 2021, including in-hospital cardiovascular complications and mortality.
- Logistic regression analysis was employed to assess sex differences, adjusting for relevant covariates.
Main Results:
- Female patients were less likely than male patients to experience cardiovascular complications (OR 0.72) or die (OR 0.65) during hospitalization.
- Common complications included supraventricular tachycardias, pulmonary embolism, and heart failure in both sexes.
- The observed sex difference in cardiovascular complication risk was not significantly modified by the presence of pre-existing cardiovascular disease.
Conclusions:
- Female patients hospitalized with COVID-19 demonstrated a lower risk of cardiovascular complications compared to male patients.
- This female advantage was independent of pre-existing cardiovascular disease prevalence.
- Further research is needed to elucidate the underlying mechanisms behind this sex-based disparity.
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 2021.
Participants:
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.
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