Sex differences in gastrointestinal bleeding among patients with cardiovascular diseases: A secondary analysis of the

Yaoyao Cai1, Jacqueline Bosch2, Jun Zhu1

  • 1Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Thrombosis Research
|May 14, 2026
PubMed

Insights

Gastrointestinal bleeding is less likely in women with cardiovascular disease (CVD). However, coronary artery disease increases bleeding risk specifically in women, highlighting sex-specific factors in CVD patients.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Epidemiology

Background:

  • Gastrointestinal (GI) bleeding is a significant complication in patients with cardiovascular disease (CVD).
  • Understanding sex differences in GI bleeding risk is crucial for targeted prevention and management strategies.

Purpose of the Study:

  • To evaluate potential sex-based disparities in the likelihood of experiencing GI bleeding among individuals with CVD.
  • To identify sex-specific risk factors associated with GI bleeding in this patient population.

Main Methods:

  • An international case-control study involving 4721 adults with CVD (1807 women, 2914 men) was conducted.
  • Data were analyzed using sequential multivariable logistic regression to assess the association between sex and GI bleeding, including sex-stratified analyses and interaction tests.

Main Results:

  • Female sex was independently linked to reduced adjusted odds of GI bleeding compared to male sex (aOR 0.82, 95% CI 0.72-0.95).
  • Coronary artery disease showed an association with increased GI bleeding odds exclusively in women (aOR 1.44; P-interaction = 0.004).

Conclusions:

  • Female patients with CVD exhibit a lower independent risk of GI bleeding.
  • While many risk factors for GI bleeding are common across sexes, specific associations, such as coronary artery disease with bleeding risk in women, were identified.
Abstract

Related Concept Videos

Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
Disorders of Hemostasis01:24

Disorders of Hemostasis

Hemostasis, the process that stops bleeding after a blood vessel injury, is crucial for maintaining the integrity of the circulatory system. However, disorders of hemostasis can disrupt this delicate balance, leading to either excessive clotting or bleeding. These disorders can be broadly classified into thromboembolic disorders and bleeding disorders.
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
Assessment of the Gastrointestinal System I: Subjective Data01:17

Assessment of the Gastrointestinal System I: Subjective Data

Assessing the gastrointestinal (GI) system is a complex process that begins with collecting subjective data. This data, collected through patient interviews, provides crucial insights into the patient's health history, perception patterns, and lifestyle habits, all contributing significantly to GI health.
Health History
The initial step in assessing the GI system is obtaining a comprehensive health history. This includes inquiring about the patient's history or presence of problems related to...
Esophageal Varices-I: Introduction01:24

Esophageal Varices-I: Introduction

Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
Assessment of the Cardiovascular System I: Subjective Data01:23

Assessment of the Cardiovascular System I: Subjective Data

A thorough health history and physical assessment are essential for identifying cardiovascular disease (CVD) symptoms and distinguishing them from other health issues.
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
Peptic Ulcer Disease I: Introduction01:30

Peptic Ulcer Disease I: Introduction

Peptic Ulcer Disease (PUD) is characterized by mucosal excavation in the esophagus, stomach, pylorus, or duodenum. It can manifest as acute or chronic based on the extent and duration of mucosal involvement.
An acute ulcer, marked by superficial erosion and minimal inflammation, swiftly resolves upon identifying and addressing the underlying cause. In contrast, a chronic ulcer persists, potentially eroding through the muscular wall and forming fibrous tissue.
Peptic ulcers can also be...