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. 2023 Feb 14;2(1):e000245.
doi: 10.1136/bmjmed-2022-000245. eCollection 2023.

Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based observational study

Carinna Hockham  1   2 , Marijke Linschoten  3 , Folkert W Asselbergs  4   5 , Chahinda Ghossein  6   7   8 , Mark Woodward  1   2 , Sanne A E Peters  1   2   9 ; CAPACITY-COVID Collaborative Consortium
Collaborators, Affiliations

Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based observational study

Carinna Hockham et al. BMJ Med. .

Abstract

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.

Keywords: COVID-19; cardiology; epidemiology; heart failure.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the Dutch Heart Foundation (Nederlandse Hartstichting), the EuroQol Research Foundation, Novartis Global, Sanofi Genzyme Europe, Novo Nordisk Nederland, Servier Nederland, and Daiichi Sankyo Nederland to establish the CAPACITY-COVID registry; The Dutch Network for Cardiovascular Research (WCN), a partner within the CAPACITY-COVID consortium, received funding from the Dutch Heart Foundation for site management and logistic support in the Netherlands; CH and MW were supported by a covid-19 research grant from the University of New South Wales, Sydney for the submitted work; MW is a consultant for Amgen, Freeline, and Kyowa Kirin and is supported by the National Health and Medical Research Council; ML is supported by the Alexandre Suerman Stipend of the University Medical Centre Utrecht; FWA is supported by the National Institute of Health Research (NIHR) University College London Hospitals Biomedical Research Centre; SAEP is supported by a UK Medical Research Council Skills Development Fellowship; no other financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Any and specific cardiovascular complications in female and male participants admitted to hospital for covid-19
Figure 2
Figure 2
Odds ratios (95% confidence intervals) for the association between sex and cardiovascular outcomes. Unadjusted and adjusted estimates are presented. In adjusted analyses, models were adjusted for age, ethnic group, history of cardiovascular disease, use of relevant drug treatment for cardiovascular disease, and risk factors for cardiovascular disease (hypertension, diabetes, dyslipidaemia, peripheral arterial disease, and body mass index)
Figure 3
Figure 3
Female-to-male odds ratios (95% confidence intervals) in patients with no pre-existing cardiovascular disease (CVD) and in those with pre-existing CVD, and corresponding ratio of odds ratio (with 95% confidence interval). Unadjusted and adjusted estimates are presented. In adjusted analyses, models were adjusted for age, ethnic group, history of cardiovascular disease, use of relevant drug treatment for cardiovascular disease, and risk factors for cardiovascular disease (hypertension, diabetes, dyslipidaemia, peripheral arterial disease, and body mass index)
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References

    1. Bhatla A, Mayer MM, Adusumalli S, et al. . COVID-19 and cardiac arrhythmias. Heart Rhythm 2020;17:1439–44. 10.1016/j.hrthm.2020.06.016 - DOI - PMC - PubMed
    1. Linschoten M, Peters S, van Smeden M, et al. . Cardiac complications in patients hospitalised with COVID-19. Eur Heart J Acute Cardiovasc Care 2020;9:817–23. 10.1177/2048872620974605 - DOI - PMC - PubMed
    1. Kermani-Alghoraishi M, Ghahramani R. A review of venous thromboembolism phenomena in COVID-19 patients. Curr Probl Cardiol 2021;46:100692. 10.1016/j.cpcardiol.2020.100692 - DOI - PMC - PubMed
    1. Long B, Brady WJ, Koyfman A, et al. . Cardiovascular complications in COVID-19. Am J Emerg Med 2020;38:1504–7. 10.1016/j.ajem.2020.04.048 - DOI - PMC - PubMed
    1. Bae S, Kim SR, Kim M-N, et al. . Impact of cardiovascular disease and risk factors on fatal outcomes in patients with COVID-19 according to age: a systematic review and meta-analysis. Heart 2021;107:373–80. 10.1136/heartjnl-2020-317901 - DOI - PubMed