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Multicenter Study
. 2022 Sep 1;323(3):H397-H402.
doi: 10.1152/ajpheart.00295.2022. Epub 2022 Jul 22.

The effects of biological sex and cardiovascular disease on COVID-19 mortality

Maria Elena Hernandez-Hernandez  1   2 , Robert Y L Zee  3   4 , Patricia Pulido-Perez  1   2 , Enrique Torres-Rasgado  2 , Jose R Romero  5   6
Affiliations
Multicenter Study

The effects of biological sex and cardiovascular disease on COVID-19 mortality

Maria Elena Hernandez-Hernandez et al. Am J Physiol Heart Circ Physiol. .

Abstract

Cardiovascular disease (CVD) is a common comorbidity observed in patients with coronavirus disease 2019 (COVID-19), which is associated with increased severity and mortality. However, the effects of biological sex on CVD-associated mortality in patients with COVID-19 are poorly established, particularly among Hispanic/Latin Americans. We examined the association of preexisting CVD with COVID-19 mortality in hospitalized Latin American men and women. This multicenter study included Mexican patients hospitalized with a positive diagnosis of COVID-19. The main outcome was in-hospital mortality. Multivariable regression analyses were used to calculate the adjusted odds ratio with 95% confidence interval for mortality in women and men. Of 81,400 patients with a positive diagnosis for SARS-CoV-2 infection, 28,929 (35.54%) hospitalized patients were evaluated. Of these, 35.41% (10,243) were women. In-hospital death was higher in men than in women. In relation to CVD between the sexes, women had a higher incidence of CVD than men (4.69 vs. 3.93%, P = 0.0023). The adjusted logistic regression analyses showed that CVD was significantly associated with COVID-19 mortality in women but not men. We then stratified by sex according to age <52 and ≥52 yr old. Similar significant association was also found in prespecified analysis in women ≥52 yr old but not in men of similar age. We conclude that CVD's effect on mortality among patients hospitalized with COVID-19 is dependent on biological sex and age in this Latin American cohort. These results suggest that therapeutic strategies for Latin American women with CVD and COVID-19 should include particular attention to their cardiovascular health.NEW & NOTEWORTHY CVD's effect on COVID-19 mortality is dependent on biological sex and age. CVD in women but not men with COVID-19 is associated with significantly unfavorable outcomes.

Keywords: COVID-19; biological sex differences; cardiovascular disease; mortality.

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Conflict of interest statement

No conflicts of interest, financial or otherwise, are declared by the authors.

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