BMJ Medicine (Jul 2023)

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

  • ,
  • Sanne A E Peters,
  • Mark Woodward,
  • Fw Asselbergs,
  • Folkert W Asselbergs,
  • B Williams,
  • GP McCann,
  • R Zaal,
  • Carinna Hockham,
  • P Dark,
  • S Prasad,
  • A Aujayeb,
  • A Mosterd,
  • M Saxena,
  • L Gabriel,
  • CE Delsing,
  • J De Sutter,
  • R Pisters,
  • P van der Meer,
  • M Caputo,
  • A Schut,
  • P van der Harst,
  • MT Kearney,
  • YM Pinto,
  • DP Ripley,
  • RG Tieleman,
  • J Redón,
  • A Moriarty,
  • P Woudstra,
  • Marijke Linschoten,
  • G Captur,
  • Chahinda Ghossein,
  • AK Al-Ali,
  • FA Al-Muhanna,
  • NYY Al-Windy,
  • YA Almubarak,
  • AN Alnafie,
  • M Alshahrani,
  • AM Alshehri,
  • RL Anthonio,
  • JM ten Berg,
  • AJM van Boxem,
  • N Charlotte,
  • HGR Dorman,
  • JT Drost,
  • ME Emans,
  • JB Ferreira,
  • WH van Gilst,
  • BE Groenemeijer,
  • HE Haerkens-Arends,
  • B Hedayat,
  • DJ van der Heijden,
  • E Hellou,
  • RS Hermanides,
  • JF Hermans-van Ast,
  • MWJ van Hessen,
  • SRB Heymans,
  • ICC van der Horst,
  • SH van Ierssel,
  • LS Jewbali,
  • HAM van Kesteren,
  • Kietselaer BLJH,
  • AMH Koning,
  • PY Kopylov,
  • AFM Kuijper,
  • JM Kwakkel-vanErp,
  • van der Linden MMJM,
  • M Linschoten,
  • GCM Linssen,
  • Macias Ruiz R,
  • FJH Magdelijns,
  • Martens FMAC,
  • MFL Meijs,
  • P Messiaen,
  • PS Monraats,
  • L Montagna,
  • PR Nierop,
  • CEE van Ofwegen-Hanekamp,
  • H Poorhosseini,
  • AC Reidinga,
  • MIA Ribeiro,
  • R Salah,
  • E Saneei,
  • J Schaap,
  • Schellings DAAM,
  • A Shafiee,
  • AC Shore,
  • HJ Siebelink,
  • M van Smeden,
  • PC Smits,
  • E Tessitore,
  • P Timmermans,
  • RA Tio,
  • FVY Tjong,
  • CA den Uil,
  • EM Van Craenenbroeck,
  • van Veen HPAA,
  • T Veneman,
  • DO Verschure,
  • JK de Vries,
  • RMA van de Wal,
  • DJ van de Watering,
  • ICD Westendorp,
  • PHM Westendorp,
  • C Weytjens,
  • E Wierda,
  • KW Wu,
  • AG Zaman,
  • PM van derZee

DOI
https://doi.org/10.1136/bmjmed-2022-000245
Journal volume & issue
Vol. 2, no. 1

Abstract

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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 2021Participants 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.