Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American Heart Association, 13(9), e029691. https://doi.org/10.1161/JAHA.123.029691 Dr. Silvi Shah et al.
Points
- This study analyzed cardiovascular event rates among 508,822 dialysis patients, focusing on sex differences in hospitalization rates for heart-related events.
- Women on dialysis had a higher cardiovascular event rate (248 per thousand person-years) compared to men (219 per thousand person-years).
- Women showed a significantly higher risk of heart failure (16% higher) and stroke (31% higher) but no significant difference in risk for acute coronary syndrome compared to men.
- Despite higher rates of cardiovascular events, women had a lower risk of cardiovascular death (11% lower) and all-cause mortality (4% lower) than men.
- The findings highlight that, although women on dialysis are more prone to specific cardiovascular issues, they experience better overall survival compared to men in this population.
Summary
This research paper investigates the relationship between sex and cardiovascular events in patients undergoing dialysis, a population at significantly increased risk for cardiovascular disease. Utilizing data from the United States Renal Data System linked with Medicare claims, the study analyzed 508,822 patients who initiated dialysis between January 1, 2005, and December 31, 2014. The cohort had a mean age of 70 years (±12 years), with 44.7% identified as women. The study specifically examined hospitalization rates for cardiovascular events, including acute coronary syndrome, heart failure, and stroke. It employed adjusted time-to-event models to assess the influence of sex on these outcomes.
The overall cardiovascular event rate was found to be 232 per thousand person-years (95% confidence interval [CI], 231–233), with a notable disparity between sexes: women experienced a rate of 248 per thousand person-years (95% CI, 247–250) compared to 219 per thousand person-years (95% CI, 217–220) for men. Women were observed to have a 14% higher risk of cardiovascular events (hazard ratio [HR], 1.14; 95% CI, 1.13–1.16), with increased risks for specific events such as heart failure (HR, 1.16; 95% CI, 1.15–1.18) and stroke (HR, 1.31; 95% CI, 1.28–1.34). However, there was no significant difference in the risk of acute coronary syndrome between sexes (HR, 1.01; 95% CI, 0.99–1.03).
Interestingly, despite the higher incidence of cardiovascular events, women in the study had a lower adjusted risk of cardiovascular death (HR, 0.89; 95% CI, 0.88–0.90) and all-cause mortality (HR, 0.96; 95% CI, 0.95–0.97) compared to men. These findings suggest that while women undergoing dialysis face more significant risks of heart failure and stroke, they have comparatively better survival outcomes regarding cardiovascular and overall mortality.
Link to the article: https://www.ahajournals.org/doi/10.1161/JAHA.123.029691
References Shah, S., Christianson, A. L., Meganathan, K., Leonard, A. C., Crews, D. C., Rubinstein, J., Mitsnefes, M. M., Schauer, D. P., & Thakar, C. V. (2024). Sex differences in cardiovascular outcomes in patients with kidney failure. Journal of the American Heart Association, 13(9), e029691. https://doi.org/10.1161/JAHA.123.029691
