Women on Dialysis Face Higher Risk of Heart Failure and Stroke than Men: Study
Researchers have found that women on dialysis face much higher risk of stroke and heart failure compared to men. A recent study was published in the Journal of the American Heart Association conducted by Sivi Shah and colleagues.
Cardiovascular disease is the leading cause of death in patients with renal failure, who have up to a 20-fold increased risk for cardiovascular events compared with the general population. This analysis, based on patient-level data from the United States Renal Data System and linked Medicare claims, examined gender differences in cardiovascular risks among patients with dialysis. Cardiovascular risks or events include heart failure, stroke, and acute coronary syndrome; mortality rates for cardiovascular causes as well as for any cause were also measured.
Data were available on 508,822 patients who received dialysis. Cardiovascular event rates, hospitalizations, and mortality endpoints were recorded. Acute coronary syndrome, heart failure, and stroke were considered to be cardiovascular events. Using time-to-event models adjusted for potential confounders, HRs for each type of event by sex were determined.
The mean age was 70 years (±12), and 44.7% were female in the population.
The cumulative rate of cardiovascular events was 232 events per 1,000 person-years (95% CI, 231–233). Rates were significantly higher in women as compared with men, at 248 per 1,000 person-years (95% CI, 247–250) as compared with 219 per 1,000 person-years (95% CI, 217–220).
Women had a 14% increased risk of cardiovascular events (HR, 1.14 [95% CI, 1.13–1.16]), including a specific 16% higher risk of heart failure (HR, 1.16 [95% CI, 1.15–1.18]) and a 31% higher risk of stroke (HR, 1.31 [95% CI, 1.28–1.34]). The risk of acute coronary syndrome was similar across genders (HR, 1.01 [95% CI, 0.99–1.03]).
Higher incidence rates for heart failure and stroke were reported among women, they compared with men had a 0.89-fold reduced risk of cardiovascular death (HR, 0.89 [95% CI, 0.88–0.90]) and a 4% reduced risk of all-cause death (HR, 0.96 [95% CI, 0.95–0.97]).
This comprehensive analysis presents significant gender-based differences in cardiovascular outcomes for dialysis patients. While being at a lower risk of both cardiovascular as well as all-cause mortality, the women were indeed at a significantly higher risk of heart failure and stroke than men. This warrants special strategies to be devised to deal with some of the cardiovascular risks that are specifically faced by women on dialysis.
Reference:
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). https://doi.org/10.1161/jaha.123.029691
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