Among patients with chronic kidney disease (CKD), the risk of atheromatous cardiovascular disease (ACVD) is lower in women compared with men, whereas non-ACVD (N-ACVD) risk does not vary by sex, reports a study in the American Journal of Kidney Diseases.
The researchers analyzed a nationally representative cohort of 1044 women and 1976 with moderate to severe CKD, drawn from the CKD-Renal Epidemiology and Information Network study. The median age was 67 years for women and 69 years for men; the mean estimated glomerular filtration rate (eGFR) was 32 and 33 mL/min/1.73 m2, respectively.
Incidence rates of ACVD events (ischemic coronary, cerebral, or peripheral artery disease) and N-ACVD events (heart failure, hemorrhagic stroke, or arrhythmias) were compared between the sexes. The median follow-up was 5.0 years.
The composite rate of fatal and nonfatal ACVD events was lower in women compared with men with CKD: 2.1 versus 3.6 per 100 patient-years. However, rates of N-ACVD events were similar between groups: 5.7 versus 6.4 per 100 patient-years.
The reduction in ACVD risk among women compared with men weakened as CKD progressed. The hazard ratio increased from 0.42 at an eGFR of 45 mL/min/1.73 m2, to 0.72 at an eGFR of 45 mL/min/1.73 m2, to no significant difference at 15 mL/min/1.73 m2.
In contrast, sex was unrelated to N-ACVD risk at any level of kidney function. This was so even after further adjustment for history of cardiovascular events. For both types of events, there were no significant interactions between sex and age, diabetes, obesity, low-density lipoprotein cholesterol, or the urine albumin-creatinine ratio.
It is unclear whether or how the known sex-related differences in cardiovascular risk—both ACVD and N-ACVD—are affected by the presence of CKD. This large cohort study confirms a lower incidence of ACVD among women with CKD compared with men. The difference, partly explained by women's better cardiovascular risk profile, “attenuates fully with kidney disease progression.”
“The equal risk of N-ACVD between sexes across CKD stages and its steeper association with eGFR suggest an important contribution of CKD to the development of this CVD type,” the researchers write. They conclude that women and men with CKD “should be considered at equally high risk for cardiovascular events, requiring close monitoring and follow-up” [Faucon A-L, et al.; CKD-REIN study collaborators. Sex and the risk of atheromatous and non-atheromatous cardiovascular disease in CKD. Am J Kidney Dis, published online June 24, 2024. doi: 10.1053/j.ajkd.2024.04.013].
