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. 2023 Apr 19;16(12):2396-2404.
doi: 10.1093/ckj/sfad088. eCollection 2023 Dec.

The impact of gender on the risk of cardiovascular events in older adults with advanced chronic kidney disease

Megan Astley  1   2 , Fergus J Caskey  3 , Marie Evans  4 , Claudia Torino  5 , Maciej Szymczak  6 , Christiane Drechsler  7 , Maria Pippias  3   8 , Esther de Rooij  9 , Gaetana Porto  10 , Vianda S Stel  1   11 , Friedo W Dekker  9 , Christoph Wanner  7 , Kitty J Jager  1   11 , Nicholas C Chesnaye  1   11 ; EQUAL study investigators
Collaborators, Affiliations

The impact of gender on the risk of cardiovascular events in older adults with advanced chronic kidney disease

Megan Astley et al. Clin Kidney J. .

Abstract

Background: Patients with chronic kidney disease (CKD) are at a higher risk of major adverse cardiovascular events (MACE) compared with the general population, but gender differences in this risk, especially in older adults, are not fully known. We aim to identify gender differences in the risk of MACE in older European CKD patients, and explore factors that may explain these differences.

Methods: The European Quality study (EQUAL) is a prospective study on stage 4-5 CKD patients, ≥65 years old, not on dialysis, from Germany, Italy, the Netherlands, Poland, Sweden and the UK. Cox regression and cumulative incidence competing risk curves were used to identify gender differences in MACE risks. Mediation analysis was used to identify variables which may explain risk differences between men and women.

Results: A total of 417 men out of 1134 (37%) and 185 women out of 602 women (31%) experienced at least one MACE, over a follow-up period of 5 years. Women had an 18% lower risk of first MACE compared with men (hazard ratio 0.82; 95% confidence interval 0.69-0.97; P = .02), which was attenuated after adjusting for pre-existing cardiometabolic comorbidities and cardiovascular risk factors. There were no significant gender differences in the risk of recurrent MACE or fatal MACE. The risk difference in MACE by gender was larger in patients aged 65-75 years, compared with patients over 75 years.

Conclusions: In a cohort of older adults with advanced CKD, women had lower risks of MACE. These risk differences were partially explained by pre-existing cardiometabolic comorbidities and cardiovascular risk factors.

Keywords: cardiovascular events; chronic kidney disease; gender differences; older adults; risk differences.

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Conflict of interest statement

M.E. report no conflict of interest in relation to this publication. Outside this work M.E. reports payment for advisory boards and lectures by Astellas pharma, Vifor Pharma and AstraZeneca, and institutional grants from AstraZeneca and Astellas pharma. C.W. had no conflict with respect to the present research. Outside this research, honoraria for consultancy and lecturing were received from Amicus, AstraZeneca, Bayer, Boehringer-Ingelheim, Eli-Lilly, GILEAD, GSK, MSD, Sanofi-Genzyme and Takeda.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Proportion of causes of first MACE experienced by men and women with CKD stage 4–5 older than 65 years of age within the EQUAL study over a 5-year follow-up period.
Figure 2:
Figure 2:
Cumulative incidence competing risk curves for the risk of first MACE in men and women over 65 years old with CKD stage 4–5 and the competing risk of non-MACE death. The category ‘First MACE’ includes both non-fatal and fatal MACE. The category ‘Alive without MACE’ includes subjects who were censored or did not have a MACE. ‘Kidney transplant’ includes patients who received a kidney transplant before having a MACE or non-MACE death. ‘Non-MACE death’ is death due to any condition not listed within our MACE definition. The at-risk tables provide an overview of the subjects at risk over the 5-year follow-up period.
See this image and copyright information in PMC

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