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Observational Study
. 2021 May;114(5):394-406.
doi: 10.1016/j.acvd.2021.04.002. Epub 2021 May 21.

Characteristics and impact of cardiovascular comorbidities on coronavirus disease 2019 in women: A multicentre cohort study

Orianne Weizman  1 , Delphine Mika  2 , Joffrey Cellier  3 , Laura Geneste  4 , Antonin Trimaille  5 , Thibaut Pommier  6 , Vassili Panagides  7 , Wassima Marsou  8 , Antoine Deney  9 , Sabir Attou  10 , Thomas Delmotte  11 , Sophie Ribeyrolles  12 , Pascale Chemaly  13 , Clément Karsenty  9 , Gauthier Giordano  14 , Alexandre Gautier  13 , Corentin Chaumont  15 , Pierre Guilleminot  6 , Audrey Sagnard  6 , Julie Pastier  6 , Baptiste Duceau  16 , Willy Sutter  16 , Charles Fauvel  15 , Théo Pezel  17 , Guillaume Bonnet  18 , Ariel Cohen  19 , Victor Waldmann  20 ; Critical COVID-19 France Investigators
Affiliations
Observational Study

Characteristics and impact of cardiovascular comorbidities on coronavirus disease 2019 in women: A multicentre cohort study

Orianne Weizman et al. Arch Cardiovasc Dis. 2021 May.

Abstract
in English, French

Background: Although women account for up to half of patients hospitalized for coronavirus disease 2019 (COVID-19), no specific data have been reported in this population.

Aims: To assess the burden and impact of cardiovascular comorbidities in women with COVID-19.

Methods: All consecutive patients hospitalized for COVID-19 across 24 hospitals from 26 February to 20 April 2020 were included. The primary composite outcome was transfer to an intensive care unit or in-hospital death.

Results: Among 2878 patients, 1212 (42.1%) were women. Women were older (68.3±18.0 vs. 65.4±16.0 years; P<0.001), but had less prevalent cardiovascular comorbidities than men. Among women, 276 (22.8%) experienced the primary outcome, including 161 (13.3%) transfers to an intensive care unit and 115 (9.5%) deaths without transfer to intensive care unit. The rate of in-hospital death or transfer to an intensive care unit was lower in women versus men (crude hazard ratio [HR]: 0.62, 95% confidence interval [CI]: 0.53-0.72). Age (adjusted HR: 1.05 per 5-year increase, 95% CI: 1.01-1.10), body mass index (adjusted HR: 1.06 per 2-unit increase, 95% CI: 1.02-1.10), chronic kidney disease (adjusted HR: 1.57, 95% CI: 1.11-2.22) and heart failure (adjusted HR: 1.52, 95% CI: 1.04-2.22) were independently associated with the primary outcome in women. Elevated B-type natriuretic peptide/N-terminal prohormone of B-type natriuretic peptide (adjusted HR: 2.41, 95% CI: 1.70-3.44) and troponin (adjusted HR: 2.00, 95% CI: 1.39-2.88) concentrations at admission were also associated with the primary outcome, even in women free of previous coronary artery disease or heart failure.

Conclusions: Although female sex was associated with a lower risk of transfer to an intensive care unit or in-hospital death, COVID-19 remained associated with considerable morbimortality in women, especially in those with cardiovascular diseases.

Justification: Bien que les femmes constituent près de la moitié des patients hospitalisés pour une infection COVID-19, il n’a pas été reporté de données spécifiques dans cette population.

Objectifs: Évaluer la fréquence et l’impact des comorbidités cardiovasculaires chez les femmes atteintes de la COVID-19.

Méthode: Tous les patients hospitalisés de façon consécutive pour une infection COVID-19 dans 24 hôpitaux ont été inclus consécutivement entre le 29 février et le 20 avril 2020. Le critère de jugement principal est le transfert en unité de soins intensifs ou al survenue d’un décès intra-hospitalier.

Résultats: Parmi les 2878 patients, 1212 (42,1 %) étaient des femmes. Les femmes étaient plus âgées (68,3 ± 18,0 vs 65,4 ± 16,0 ans, p < 0,001) mais présentaient moins de comorbidités cardiovasculaires par rapport aux hommes. Parmi les femmes, 176 (22,8 %) ont présenté un évènement incluant 161 patients (13,3 %) ont dû être transférées en unité de soins intensifs et 115 (9,5%) sont décédées, sans transfert dans une unité de soins intensifs. Le taux de décès intra-hospitaliers ou de transferts dans une unité de soins intensifs était moindre chez les femmes comparativement aux hommes (HR brut : 0,62, IC95 % : 0,53–0,72). L’âge (HR ajusté : 1,05 par tranche de 5 ans, IC95 %: 1,02–1,1), l’insuffisance rénale chronique (HR ajusté : 1,57, IC95 % : 1,11–2,22) et l’insuffisance cardiaque (HR ajusté: 1,52, IC95 % : 1,02–2,22) étaient indépendamment associés avec la survenue du critère de jugement principal chez la femme. Une élévation du peptide natriurétique (BNP) ou du NT-pro-BNP (HR ajusté : 2,41, IC95 % : 1,73–3,44) et une élévation de la troponine (HR ajusté : 2,00, IC95 % : 1,39–2,88) à l’admission étaient également associés avec la survenue du critère de jugement principal, y compris chez les femmes n’ayant pas de maladie coronaire ou d’insuffisance cardiaque avérée.

Conclusion: Bien que le sexe féminin soit associé avec un risque moindre de transfert en unité de soins intensifs ou de survenue de décès hospitalier, la COVID-19 associée à une augmentation de la morbi-mortalité chez la femme en particulier chez celle ayant une maladie cardiovasculaire sous-jacente.

Keywords: COVID-19; Facteurs de risque; Femmes; Outcomes; Risk factors; Résultats; SARS-CoV-2; Women.

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Figures

Figure 1
Figure 1
Study flow chart. ICU: intensive care unit.
Figure 2
Figure 2
A. Survival without transfer to intensive care unit (ICU) or in-hospital death (adjusted on age, body mass index, chronic kidney failure, diabetes, hypertension, coronary artery disease, heart failure and dyslipidaemia). B. Survival without in-hospital death in women versus men (adjusted on age, chronic kidney failure, diabetes and heart failure).
Figure 3
Figure 3
A. Impact of cardiovascular comorbidities on outcomes in women hospitalized for coronavirus disease 2019 (COVID-19). B. Impact of cardiovascular comorbidities on outcomes in men hospitalized for COVID-19. ICU: intensive care unit.
Figure 4
Figure 4
Forest plot of primary outcome and in-hospital death in women in the multivariable analysis. a Increment of 5. b Increment of 2.
See this image and copyright information in PMC

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