Sex Differences in Clinical Characteristics, Treatment, and Outcomes of Cardiovascular Disease: Kenya Heart Registry
Lilian Mbau1, Martha Gulati2, Mzee Ngunga3
1Research Department, Centre for Cardiovascular Prevention and Rehabilitation, Nairobi, Kenya.
Insights
Sex differences in cardiovascular disease clinical profiles exist in Kenya, but treatment and outcomes are similar. Evidence-based interventions are crucial to reduce high mortality rates in this population.
Area of Science:
- Cardiology
- Global Health
- Sex Differences in Medicine
Background:
- Cardiovascular disease (CVD) is a leading global cause of death, disproportionately affecting low- and middle-income countries.
- Sex differences in CVD are well-documented in high-income nations but understudied in low-resource settings.
- Limited data exists on sex-specific CVD profiles in African populations.
Purpose of the Study:
- To investigate sex disparities in the clinical presentation of cardiovascular disease.
- To evaluate differences in cardiovascular risk profiles between men and women.
- To compare diagnostic and treatment strategies and their impact on outcomes in the Kenya Heart Registry.
Main Methods:
- Prospective data collection from 1,687 patients across 3 tertiary hospitals in Kenya.
- Analysis included patients with heart failure, acute coronary syndrome, venous thromboembolism, and atrial fibrillation.
- Primary outcomes assessed were in-hospital and 6-month mortality, alongside sex-specific clinical and risk factor data.
Main Results:
- Women constituted 51.3% of the study cohort and were younger on average.
- Women presented with higher rates of heart failure with preserved ejection fraction, venous thromboembolism, and atrial fibrillation; men had more acute coronary syndrome.
- No significant sex differences were found in diagnostic procedures, treatment adherence, or in-hospital and 6-month all-cause mortality.
Conclusions:
- While significant sex differences exist in the clinical profiles of cardiovascular disease patients in Kenya, management approaches and mortality outcomes were similar between sexes.
- There is an urgent need to implement and scale evidence-based interventions to address the high burden of cardiovascular mortality in this population.
- Further research into sex-specific risk factors and tailored interventions is warranted.
Background:
Cardiovascular disease is the leading cause of death globally, with approximately 80% of these deaths occurring in low- and middle-income countries. Sex differences in cardiovascular disease are well described in high-income countries but limited in low- and middle-income countries.
Objectives:
This study sought to evaluate the sex differences in clinical presentation, cardiovascular risk profile, diagnosis, treatment, and outcomes among patients in the Kenya Heart Registry.
Methods:
Data were prospectively collected from 3 tertiary hospitals, including patients with heart failure, acute coronary syndrome, venous thromboembolism, and atrial fibrillation. Primary outcomes were in-hospital and 6-month mortality, as well as sex-specific differences in clinical presentation, cardiovascular risk factors, diagnosis, and treatment.
Results:
Among 1,687 participants, 51.3% were women. Of these, 1,241 were admitted, while 446 were managed as outpatients. Women were younger (50.9 vs 54.2 years; P < 0.001), had lower monthly income, higher left ventricular ejection fraction, higher rates of heart failure with preserved ejection fraction, venous thromboembolism, and atrial fibrillation, and lower rates of acute coronary syndrome than men. No sex difference was observed in diagnostics or treatment or adherence to guideline-directed therapies. In-hospital and 6-month all-cause mortality were 7.4% and 14.7%, respectively, and were similar by sex (women 8.0% and 14.8% vs men 6.9% and 14.5%; P = 0.449 and P = 0.881, respectively).
Conclusions:
Significant sex differences exist in clinical profiles, but management and outcomes are similar. Scaling up evidence-based interventions is urgently needed to reduce the high mortality in this population.
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